STUDENT ASSESSMENT

REGISTRATION

One-on-One Tutoring

Orton-Gillingham Instruction
Intervention for Struggling Readers
Phonics, Reading Comprehension, and Writing Skills
Executive Function and Organization Skills

Dyslexia, ADHD, Auditory & Visual Processing skills
Learning Disabilities Instruction
Multi-sensory Math

Registration Form

We help children with reading problems, including dyslexia, auditory & visual processing disorders, ADHD, and Autism Spectrum Disorders. We use research-based, multi-sensory strategies to help those struggling readers build their academic skills, motivation, self-confidence, and obtain success in school.

Our students often improve up to two grade levels using our individualized techniques.

We begin with each student by interpreting previous testing, if available, and performing our own clinical evaluation to develop an individualized student learning
plan. We use our multi-sensory methods to achieve academic success. We aim to fill in the learning gaps to prevent these achievement gaps from widening.

To register for an assessment with Dr Deborah Levy, please complete the Registration Form, then complete the credit card form to authorize a $75 charge for the evaluation. If you need a written evaluation, there will be an additional fee depending on what is required.

Student’s First Name*

Student’s Last Name*

Student’s Address*

City*

State*

Zip*

Student’s Birthdate*

Student’s Home Phone

Student’s Cell Phone

Parents are*

Living Situation (who the child lives with)*

School Attended*

Student’s Grade*

Teacher’s Name*

Teacher’s Email Address

School Principal’s Name*

School Principal’s Email Address

Referred by*

Mother’s First Name

Mother’s Last Name

Check if Mother’s address is same as student's

Mother’s Address

City

State

Zip

Mother’s Work Phone

Mother’s Cell Phone

Mother’s Email Address

Father’s First Name

Father’s Last Name

Check if Father’s address is same as student's

Father’s Address

City

State

Zip

Father’s Work Phone

Father’s Cell Phone

Father’s Email Address

Guardian’s First Name

Guardian’s Last Name

Check if Guardian’s address is same as student's

Guardian’s Address (if different)

City

State

Zip

Guardian’s Home Phone

Guardian’s Cell Phone

Guardian’s Email Address