PSYCHOLOGICAL REPORT FORMAT

PERSONAL DATA/DEMOGRAPHIC DATA

Name:
Age:
Sex:
Date of Birth:
Ethnicity/Race
Date of Assessment:
Date of Report:
Referred By:
Name of Examiner:

I. Referral Question/Reason for Referral /Purpose of Evaluation

II. Evaluation Procedures
III. Behavioral Observations
IV. Relevant History of Client/Background Information
V. TEST RESULTS (Show scoring as required)
VI. Interpretations/Impressions/FINDINGS
VII. SUMMARY
VIII. RECOMMENDATIONS