New Patient Inquiry Form : TESTING EVALUATION
You have reached the new patient inquiry form for Psychological/Neuropsychological Testing at Creekview Psychological Assessment Center located in  Newark, Delaware. 

Please complete this form if you are interested in learning more about having a psychological or neuropsychological testing evaluation completed by one of our clinical & neurodevelopmental psychologists.

Our Creekview Clinicians: 
  • Michele Turley., M.Ed., Psy.D., ABSNP
  • Gina Mattei, Ph.D.
  • Wallesca Castro Rodriguez Subasic, Psy.D.
  • Rolf Ritchie, Ph.D.
The information you provide through this confidential webform, will allow us to make sure Creekview is the right team to assist you and match you with one of our psychologists. All inquiries submitted here are reviewed within 5 business days. One of our psychologists will contact you by email about scheduling an intake appointment. 

Additional information about our providers, services, and procedures can be found on our website at www.creekvewtesting.com. 

Email *
We send out very occasional email newsletters with updates about new providers, new services offered, and other updates at Creekview. If you would NOT like to receive these updates in the future, please check the box below. 
Patient First Name  *
Patient Last Name *
Parent/legal guardian full name 
(If patient is a minor or has a legal guardian)
Phone number
Patient Birthdate *
MM
/
DD
/
YYYY
In which state does the patient live? *
Why are you seeking an evaluation at this time?  *
Are there any specific diagnoses for which you are hoping to be evaluated or want to learn more about? Please list them below.
How do you plan to use the results of your evaluation? 

Select all that apply
If you have had an evaluation completed before, briefly describe the results:
Is there anything else you would like us to know?
Are you interested in working with a specific psychologist on our team? 

OPTIONAL -- you can select none, more than one, or pick  the "any team member" option.
Do you have any mobility limitations that would require assistance with stairs and/or elevator access? 
Clear selection
Thank you!
Please know that while we will make our best effort to connect you with your preferred provider,  our main priority is matching you with the clinician who can best answer your evaluation questions. For this reason, we may recommend a different provider than the one(s) you selected for their area of expertise, specific skillset, or availability.  

When you press submit below, your responses will be saved for our team to review.
You will hear from one of our psychologists by email within 5 business days. 

If you do not hear from us within this timeframe, please assume a technical error has occurred and let us know by contacting our Office Manager,  Meghan Lees,  by email at   mlees@creekviewtesting.com .

We look forward to meeting you!

Sincerely, 
The Team at Creekview Assessment Center

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