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The following forms are downloadable PDFs, in which you may type and save your responses. Completed paperwork may be e-mailed to the Assistant Director or mailed to the address below.

For adult clients, please submit the following:

Adult Clinical Interview

For child/adolescent clients, please submit the following:

Child Clinical Interview

All clients should read the following:
Notice of Privacy Practices

If you have questions about these forms or would like to submit completed paperwork via e-mail, please contact the Assistant Director at 801-581-6068.

Please send all mail correspondence to:

Department of Educational Psychology
1721 E. Campus Center Drive, SAEC 3220
Salt Lake City, UT 84112

Last Updated: 8/27/19