Welcome!

Below is the online referral form for an evaluation through the Shapam service, a branch of the Educational Psychological Services of Efrat.

Please complete this questionnaire, and Psychological Services staff will be in touch with you as soon as we are able. Please take into account that there may be a wait until a psychologist is available to do the evaluation. 

  1.  

For the Hebrew version, click on the language button (עב) on the upper right side of this page.

  ניתן לענות בעברית בלחיצה על כפתור השפה (עב) בחלק העליון של עמוד זה בצד הימני של המסך.

 

Type of education
Type of education (required) שדה חובה
Parents marital status
Parents marital status (required) שדה חובה
Type of evaluation requested
Type of evaluation requested (required) שדה חובה
Have there been any previous evaluations?
Have there been any previous evaluations? (required) שדה חובה
If yes, please choose which kind
If yes, please choose which kind
?What is the student's primary language
?What is the student's primary language (required) שדה חובה
Is there a preference for an English-speaking psychologist? (We will try to accommodate your request, but we cannot guarantee it.)
Is there a preference for an English-speaking psychologist? (We will try to accommodate your request, but we cannot guarantee it.) (required) שדה חובה
How did you hear about us?
How did you hear about us? (required) שדה חובה
I am confirming that I understand: Payment for evaluations is made through the billing department (Machleket Gviya) in the moetza, and must be made ahead of time
I am confirming that I understand: Payment for evaluations is made through the billing department (Machleket Gviya) in the moetza, and must be made ahead of time (required) שדה חובה
Rates: Psycho-didactic evaluation - 3080 shekel (if there is a use of the MOXO test there will be an additional charge of 50 shekel). ADHD evaluation (including the MOXO) - 610 shekel.