Please read and/or complete the following forms and return them prior to your initial visit.
- Office Policies (read only)
- HIPAA Illinois Notice Form (read only)
- Consent for Assessment and HIPAA Signature Pages: To access all fields, the document must first be saved and then opened from the saved file.
- Credit Card Information: To access all fields, the document must first be saved and then opened from the saved file.
- Family History Form (to be completed by family)
- School Form (to be completed by teachers)
- Release of Information: Please complete this form if you would like us to communicate with other individuals involved in your (patients over 18 years old) or your child’s care (patients under 18 years old). To access all fields, the document must first be saved and then opened from the saved file.
We kindly request that children 12 years and older sign the “consent for assessment” and “release of information” forms in addition to their parent.
If you are interested in a neuropsychological assessment or would like to ask us any questions to determine if it is right for your child, please contact us.