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Ekdom Neuropsychology Group

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The best way to start the process of scheduling an appointment with us is to complete the form below. You can also call us at (703) 573-3573 during our office hours and directly talk to one of our intake specialists.

* Indicates required field

I Am Interest In Scheduling an Appointment for the Following: *

Comprehensive Neuropsychological Evaluation Accommodations Testing Independent Educational Evaluation (IEE) ADHD Screening Assessment Memory Screening Assessment Autism Evaluation Consultation Post-Assessment Feedback Session Neurofeedback Talk Therapy Auditory Integration Training Other/Not Sure

Please Describe Your Primary Concerns: *

Name *

First

Last

Address *

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City

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Date of Birth: *

Grade/Highest Level of Academic Achievement: *

Right or Left Handed? *

Right Handed Left Handed Ambidextrous

Father’s Name (If Minor): *

Mother’s Name (If Minor): *

Spouse’s Name (If Married): *

Email Address: *

Phone Number: *

Insurance Company: *

Do you understand that we are not contracted with any insurance company other than Medicare? *

Yes No

Do you have Medicaid? *

Yes No

Name of Referring Doctor (If Applicable): *

Name of Pediatrician (If Applicable): *

Is this Evaluation Related to a Workerman’s Compensation Case? *

Yes No

Are You Seeking This Evaluation in Preparation For Litigation? *

Yes No

How Did You Find Us? *

Submit Your Appointment Request

PHONE

(703) 573-3573

Address

3040 Williams Drive, Suite 402
Fairfax, Virginia 22031

Hours

MonDAY - FriDAY
9:30am - 4:30pm

© Copyright 2023 Ekdom Neuropsychology Group

About Us
Services
Appointments
- Types of Appointments
- Request an Appointment
FAQ
Blog
Contact
- Non-Appointment Inquiries
- Request an Appointment