FORMAT OF THE PSYCHOLOGICAL TEST REPORT

PERSONAL DATA
Name:
Area of Confinement:
Age: Civil Status:
Birthdate:
Birthplace:
Educational Attainment:
Referred for:
Referred by:
Date Examined:

GENERAL OBSERVATION
– Physical Appearance / Description
– HPI
– Substance History
– Family History
– Behavioral Report

TESTS ADMINISTERED
(for example)
WAIS-R / WISC-R
BVMGT
DAPT
SSCT

TEST RESULTS AND EVALUATION

WAIS-R VERBAL SCALE IQ - ________

PERFORMANCE SCALE IQ - ________
FULL SCALE IQ - ________
CLASSIFICATION - __________________________

(Discuss the current and premorbid IQ)

(Discuss the analysis of subtest scores)

BENDER VISUAL MOTOR GESTALT TEST

(Discuss the results)

DRAW A PERSON TEST

(Discuss the results)

SACKS SENTENCE COMPLETION TEST

(Discuss the results)

GENERAL SUMMARY

- Intellectual Ability
- Emotional Functioning / Status
- Social Aspect
- Sexual Aspect
- Defense Mechanisms

Test Administered and Evaluated by:

Name and Signature

School