DELAWARE MODERN PEDIATRICS, P.A.

David M. Epstein, M.D.

300 Biddle Avenue, Suite 206

Springside Plaza, Connor Building

Newark, Delaware 19702

Phone: (302) 392-2077

Fax: (302) 392 - 0020

www.DelawareModernPediatrics.com

Dear Teacher, Date:

The parents of your student, , have asked me to evaluate him/her for the possibility of an attention problem. It will be quite helpful for me to know your observations about school performance. I will find your written professional opinion to be more helpful than preprinted rating scales.

In particular, there are several questions that I would like your opinion about. Please comment on this child’s performance in the following areas:

1. Academic progress and performance in the subjects you teach.

2. Classroom behavior, and cooperation with class routines.

3. Your perceptions of social interactions with his/her peers.

4. Ability to stay focused on class discussions, and his/her appropriate participation.

5. The quality of class work done in school, with regard to neatness, organization of work, ability to complete work within the allotted time, and his/her understanding of the concepts.

6. Organization and study skills.

7. The completion and correctness of homework.

8. The presence or absence of excessive careless errors.

9. Your perception of academic and social strengths that we can use as resources.

10. Other pertinent observations you may have made.

I am grateful for your assistance in noting your observations. You may mail or fax them to me at my office (above). You may decide to give the parents a copy also.

If you have any questions, I would be pleased to speak with you; please call the number above.

Thank you for your assistance.

Sincerely,

David M. Epstein, M.D. © David Marc Epstein, MD 2007