NO SURPRISE BILLING DISCLOSURE

This is a No Surprise Billing Disclosure 

CONSENT TO OBTAIN INFORMATION

This is the Consent to Obtain Information

Email Authorization Form

This is the Email Authorization Form

Dr. Meredith Hickory

Pediatric Neuropsychologist

pEDIATRIC nEUROPSYCHOLOGY

A Guide for Patients and Their Families

Consent To Release Report

This is the Consent To Release Report

CLIENT SERVICES AGREEMENT

This is a copy of Client Services Agreement

Informed Consent (2021)

This is the Informed Consent

Notice of Privacy Policy (2021)

This is the Notice of Privacy Policy

Insurance Waiver

This is the Insurance Waiver

Child History Questionnaire

This is the Child History Questionnaire

HIPPA Disclosure

This is the HIPPA Disclosure

TREATMENT PROVIDERS HISTORY

This is the Treatment Providers History

​Informed Consent TELEPSYCHOLOGY

This is the Informed Consent Telepsychology

Educational Addendum

This is the Educational Addendum

Informed Consent Face To FACE

This is the Informed Consent Face to Face (COVID)