Luke Waites Center for Dyslexia and Learning Disorders

Pre-Approval Steps

Thank you for your interest in the Luke Waites Center for Dyslexia and Learning Disorders.
Note: If your child is approved, there is an evaluation fee of $900 due before testing. Scottish Rite offers a financial assistance program called Crayon Care, and all families are encouraged to apply to help reduce their portion of this fee.

Step 1: Complete the Form Below

Request access to receive information securely online. This is our primary form of communication with you.

Step 2: Activate Proxy (link texted to you)

Within 2-3 business days, you will receive an activation link. You must activate MyChart access to receive the requested application. Access and submit your child’s application.

Be prepared to provide copies of prior testing / evaluation, any relevant school documentation and a copy of your identification (driver’s license, passport, etc.).

Step 3: Complete & Submit the Application

After you submit the application, the Application Committee will review it. You will receive eligibility information through MyChart within 3 weeks.

MyChart Request Form – Step One

You are going to be given access to an easy-to-use online tool to securely submit your child's information (MyChart). Before you start, please be aware that:

• Access can only be given to a parent or legal guardian.
• Your child must be:
• a Texas resident
• between the ages of 5 and 14 years
• a proficient English speaker 		✓
✓
✓

If you who would like to receive an application to the Center for Dyslexia, please complete the following information.

The child’s biological/adoptive parents are:
With whom does the child primarily reside? (You can check more than one box)

Parent 1 / Guardian / Legally Responsible Person Information
 

Date of birth of the parent or legal guardian.

Sex
Do you have an existing MyChart account with Scottish Rite?
Parent 2 / Guardian / Legally Responsible Person Information
 

Date of birth of the parent or legal guardian.

Sex
Do you have an existing MyChart account with Scottish Rite?
Child's Information
 
Sex
Parent 1 Relationship to Child
Parent 2 Relationship to Child
Legal guardian for this child is?

 
Additional Child’s Information

Only enter information here if you’d like to have an additional child evaluated.


 
Sex
Parent 1 Relationship to Child
Parent 2 Relationship to Child
Legal guardian for this child is?

 
Certification

I certify that I am the patient or legally authorized representative of the patient. By signing this form, I acknowledge that I have read and understand this myChart Request Form and I agree to its terms and conditions. I hereby request access to my child and/or children’s online health record.

Certification


If you have any questions, please contact the Center for Dyslexia at 214-559-7815.