| Overview of Adoption Evaluation Process |
Background
1. Dr. David Lombard will be the only psychologist involved in your evaluation through our office. Dr.
Lombard has been licensed in this state since 1999. Being licensed requires passing a national
written examination and a written examination given by the Indiana State Psychology Examining
Board. You may contact them with questions or concerns at 55 Monument Circle Suite 455,
Indianapolis, Indiana 46204.
2. In this information sheet we will try to cover issues which come up frequently in adoption
evaluations. Please take the time to read through it and then feel free to ask questions of Dr.
Lombard in your initial appointment.
Purpose, Process, and Limitations of the Evaluation
1. It is important that you understand in advance that this is an independent evaluation. There is a
possibility that Dr. Lombard’s impressions may be unfavorable to your position. Dr. Lombard will be
making recommendations consistent with the clinical interview, document review and psychological
testing findings.
2. The evaluation itself will consist of interviews and psychological testing. The psychological testing
allows Dr. Lombard to collect a wide range of data and organize the issues while minimizing cost to
you. At the end of the evaluation, a report and recommendation will be provided to the appropriate
parties depending on your case.
3. Dr. Lombard recognizes that his impressions are very important to you. However, please do not
ask him to give you an opinion until he had had an opportunity to hear all information, review the
psychological test results, and fully review the file. At that time, feedback will be given either verbally
or in written form.
Confidentiality Issues
1. As Dr. Lombard begins the evaluation you will be asked to sign "Release of Information" forms.
This allows Dr. Lombard to discuss this situation with anyone who he thinks would be helpful in
coming to a recommendation. This also allows Dr. Lombard to talk to your adoption agency and
submit reports to your adoption country (if required in your case). The laws of confidentiality might
otherwise prevent him from doing so.
Evaluation Costs
1. The fee for a complete adoption evaluation is $350 to be paid at the time of service. Dr. Lombard
will accept cash, check, or credit cards. Dr. Lombard does not bill insurance companies for services
rendered. However, Dr. Lombard will give you a detailed receipt for you to submit for reimbursement.
Dr. Lombard cannot offer any guarantee that your insurance carrier will reimburse you for his
services.
2. There will also be charges of $150 for any missed or canceled appointment where 72 hour notice
is not given. Any unpaid bills will accrue interest at the rate of 18% per annum. A $20.00 surcharge
will be assessed for any returned checks.
The Evaluation Process
The following describes the steps and the purposes of the procedures that are involved in this
evaluation process. The description is being given so that you know what to expect as you decide to
have an evaluation done and as you prepare for and go through this evaluation. This evaluation will
follow a structured pattern to maximize the fairness and the objectivity of the report. However, Dr.
Lombard may make changes in the process in a case by case basis due to the needs of each case.
1. At your initial appointment, you should bring any written documents that you might think would
be relevant to your case. (It is very rare that additional background documents are needed in an
adoption evaluation.) Please highlight the segments of the documents that you think are noteworthy.
2. In the first part of your clinical interview you and Dr. Lombard will review the consent for
evaluation form, answer any questions you have, and have you sign that document. Also, if your
specific country requires completion of specific paperwork, this will be when those documents will
be reviewed. For example, certain eastern European countries have specific forms to be completed
by the evaluator.
3. Dr. Lombard will conduct a detailed clinical interview with you and your spouse (if you are
married). The interviews will have special focus on mental health issues and your readiness for
adoption.
4. After the clinical interview(s), you will complete the Personality Assessment Inventory. This
psychological test is one of the most researched and standardized tests in use today.
5. Following your structured interview and testing, releases of information will be signed so that
the relevant records may be obtained and so that third-party individuals can be contacted who may
be able to help with the evaluation.
6. Collaterals will be interviewed if appropriate.
7. All of the documents will be reviewed.
8. A follow-up interview will occur if needed in your case.
9. The payment is due on the day of your evaluation.
10. Changes may occur in the process due to the situation in each case. The evaluator still
attempts to complete all the objectives of the evaluation.
If after reviewing this information you have questions, please be sure to discuss them with me at
your initial interview when I will more fully explain the evaluation procedure you are about to begin.
1. Dr. David Lombard will be the only psychologist involved in your evaluation through our office. Dr.
Lombard has been licensed in this state since 1999. Being licensed requires passing a national
written examination and a written examination given by the Indiana State Psychology Examining
Board. You may contact them with questions or concerns at 55 Monument Circle Suite 455,
Indianapolis, Indiana 46204.
2. In this information sheet we will try to cover issues which come up frequently in adoption
evaluations. Please take the time to read through it and then feel free to ask questions of Dr.
Lombard in your initial appointment.
Purpose, Process, and Limitations of the Evaluation
1. It is important that you understand in advance that this is an independent evaluation. There is a
possibility that Dr. Lombard’s impressions may be unfavorable to your position. Dr. Lombard will be
making recommendations consistent with the clinical interview, document review and psychological
testing findings.
2. The evaluation itself will consist of interviews and psychological testing. The psychological testing
allows Dr. Lombard to collect a wide range of data and organize the issues while minimizing cost to
you. At the end of the evaluation, a report and recommendation will be provided to the appropriate
parties depending on your case.
3. Dr. Lombard recognizes that his impressions are very important to you. However, please do not
ask him to give you an opinion until he had had an opportunity to hear all information, review the
psychological test results, and fully review the file. At that time, feedback will be given either verbally
or in written form.
Confidentiality Issues
1. As Dr. Lombard begins the evaluation you will be asked to sign "Release of Information" forms.
This allows Dr. Lombard to discuss this situation with anyone who he thinks would be helpful in
coming to a recommendation. This also allows Dr. Lombard to talk to your adoption agency and
submit reports to your adoption country (if required in your case). The laws of confidentiality might
otherwise prevent him from doing so.
Evaluation Costs
1. The fee for a complete adoption evaluation is $350 to be paid at the time of service. Dr. Lombard
will accept cash, check, or credit cards. Dr. Lombard does not bill insurance companies for services
rendered. However, Dr. Lombard will give you a detailed receipt for you to submit for reimbursement.
Dr. Lombard cannot offer any guarantee that your insurance carrier will reimburse you for his
services.
2. There will also be charges of $150 for any missed or canceled appointment where 72 hour notice
is not given. Any unpaid bills will accrue interest at the rate of 18% per annum. A $20.00 surcharge
will be assessed for any returned checks.
The Evaluation Process
The following describes the steps and the purposes of the procedures that are involved in this
evaluation process. The description is being given so that you know what to expect as you decide to
have an evaluation done and as you prepare for and go through this evaluation. This evaluation will
follow a structured pattern to maximize the fairness and the objectivity of the report. However, Dr.
Lombard may make changes in the process in a case by case basis due to the needs of each case.
1. At your initial appointment, you should bring any written documents that you might think would
be relevant to your case. (It is very rare that additional background documents are needed in an
adoption evaluation.) Please highlight the segments of the documents that you think are noteworthy.
2. In the first part of your clinical interview you and Dr. Lombard will review the consent for
evaluation form, answer any questions you have, and have you sign that document. Also, if your
specific country requires completion of specific paperwork, this will be when those documents will
be reviewed. For example, certain eastern European countries have specific forms to be completed
by the evaluator.
3. Dr. Lombard will conduct a detailed clinical interview with you and your spouse (if you are
married). The interviews will have special focus on mental health issues and your readiness for
adoption.
4. After the clinical interview(s), you will complete the Personality Assessment Inventory. This
psychological test is one of the most researched and standardized tests in use today.
5. Following your structured interview and testing, releases of information will be signed so that
the relevant records may be obtained and so that third-party individuals can be contacted who may
be able to help with the evaluation.
6. Collaterals will be interviewed if appropriate.
7. All of the documents will be reviewed.
8. A follow-up interview will occur if needed in your case.
9. The payment is due on the day of your evaluation.
10. Changes may occur in the process due to the situation in each case. The evaluator still
attempts to complete all the objectives of the evaluation.
If after reviewing this information you have questions, please be sure to discuss them with me at
your initial interview when I will more fully explain the evaluation procedure you are about to begin.
Downloadable Forms
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Legalshrink.com
David Lombard, Ph.D
Licensed Clinical Psychologist
260-459-2900
Lombard@legalshrink.com
David Lombard, Ph.D
Licensed Clinical Psychologist
260-459-2900
Lombard@legalshrink.com