Intake Forms

                                     

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Please open and print out the appropriate file which contains all of the forms which you will need to fill out prior to your first appointment.  If you have any questions or concerns, please feel free to contact the office.

If you are bringing your child for an evaluation to rule out ADD/ADHD, a learning disability or a psychological/behavioral problem, please fill out the following forms:

                Child Psychology Intake Package.pdf

If you are bringing your child for an evaluation of a neurological disorder, please fill out the following forms:

                Child Neuropsychology Intake Package.pdf

                Schuyler Brain Injury Adaptive Functioning Inventory.pdf

If you are coming here personally for an evaluation to rule out ADD/ADHD, a learning disability or a psychological problem, please fill out the following forms:

                Adult Psychology Intake Package.pdf

If you are coming here personally for an evaluation of a neurological disorder, please fill out the following forms:

                Adult Neuropsychology Intake Package.pdf

                Schuyler Brain Injury Adaptive Functioning Inventory.pdf

If you need for this office to send or request information from another doctor or institution, please fill out the following form:

                Release of Information.pdf

You will require Adobe Reader to open these documents which can be downloaded at the following site:

                http://www.adobe.com/products/acrobat/readstep2.html