Intake Form — LSAT Access

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Personal Information

Basic contact and demographic details

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

State of Residence *

Preferred Pronouns

Highest Level of Education *

Current / Most Recent GPA (if applicable)

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LSAT & Testing Details

Information about your planned exam and accommodation goals

Planned LSAT Test Date *

Have you taken the LSAT before? *

Previous LSAT Score (if applicable)

Did you receive accommodations on a prior LSAT?

Which accommodations are you seeking? *

Select all that apply

50% Extended TimeStandard extra time — 1.5× the normal allotment per section

100% Extended TimeDouble time — 2× the normal allotment per section

Additional BreaksExtra rest periods between or during sections

Remote Testing ExceptionPermission to test from home rather than a testing center

Other / UnsureI'm not sure what I qualify for — let the clinician advise me

Have you received academic accommodations in school (e.g., extended time on exams)?

YesI have received accommodations in school

NoI have not received school accommodations

If yes, please describe the accommodations you received and for how long

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Medical & Diagnostic History

Prior diagnoses, treatment history, and healthcare providers

Do you have any existing diagnoses? *

Select all that apply

ADHD / ADDAttention-Deficit/Hyperactivity Disorder or Attention-Deficit Disorder

Learning DisabilityDyslexia, dyscalculia, dysgraphia, or other learning differences

Anxiety DisorderGeneralized anxiety, panic disorder, social anxiety, OCD, or related conditions

Depression / Mood DisorderMajor depressive disorder, bipolar disorder, or related conditions

PTSD / TraumaPost-traumatic stress disorder or other trauma-related conditions

Autism Spectrum DisorderASD or related neurodevelopmental conditions

Physical / Medical ConditionChronic illness, autoimmune disorder, neurological condition, or other physical diagnosis

Vision or Hearing ImpairmentVisual or auditory conditions affecting test-taking

No Prior DiagnosisI have not been formally diagnosed but believe I may qualify

Please describe any diagnoses in more detail (including when you were diagnosed)

Are you currently receiving treatment or therapy?

Are you currently prescribed any medications?

If yes, please list current medications (optional) This information is kept strictly confidential and used only to inform your evaluation.

Do you have prior psychological or neuropsychological testing records?

Yes, availableI have records I can share

Yes, but unavailableRecords exist but I can't access them

NoI have never had formal testing

UnsureI'm not sure if records exist

Name and credentials of your current or most recent mental health provider (if any)

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Symptoms & Functional Impact

How your condition affects your daily life and test performance

Please describe how your symptoms specifically affect your ability to take timed tests *

Rate the severity of your symptoms on a typical day

Attention / Focus difficulties

None Severe

Anxiety / Stress

None Severe

Fatigue / Low energy

None Severe

Physical discomfort / Pain

None Severe

How long have you experienced these symptoms?

Have your symptoms impacted your academic performance? *

Yes, significantlyNoticeably lower grades or performance than my ability

Yes, somewhatSome impact but I've managed with extra effort

Not noticeablyMy grades don't reflect the difficulty I experience

Please describe any specific examples of how your condition has impacted your academic or professional performance

Have you ever been told by a teacher, professor, or employer that you work more slowly than expected?

Yes

No

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Additional Information

Scheduling preferences and anything else relevant to your evaluation

How did you hear about LSAT Access?

Is there anything else you would like your evaluating clinician to know before your session?

Preferred availability for your remote evaluation session *

Select all that apply

Weekday mornings (9am–12pm ET)

Weekday afternoons (12pm–5pm ET)

Weekday evenings (5pm–8pm ET)

Weekends (Saturday or Sunday)

Preferred contact method for scheduling

Email

Phone call

Text message

Begin Your Accommodation Evaluation

Personal Information

LSAT & Testing Details

Medical & Diagnostic History

Symptoms & Functional Impact

Additional Information

Intake Form Submitted!