Consent To Release Report
This is the Consent To Release Report
Email Authorization Form
This is the Email Authorization Form
Dr. Meredith Hickory
Pediatric Neuropsychologist
Informed Consent (2021)
This is the Informed Consent
pEDIATRIC nEUROPSYCHOLOGY
A Guide for Patients and Their Families
Insurance Waiver
This is the Insurance Waiver
Notice of Privacy Policy (2021)
This is the Notice of Privacy Policy
CLIENT SERVICES AGREEMENT
This is a copy of Client Services Agreement
Child History Questionnaire
This is the Child History Questionnaire
HIPPA Disclosure
This is the HIPPA Disclosure
NO SURPRISE BILLING DISCLOSURE
This is a No Surprise Billing Disclosure
Educational Addendum
This is the Educational Addendum
TREATMENT PROVIDERS HISTORY
This is the Treatment Providers History
Informed Consent TELEPSYCHOLOGY
This is the Informed Consent Telepsychology
Informed Consent Face To FACE
This is the Informed Consent Face to Face (COVID)
CONSENT TO OBTAIN INFORMATION
This is the Consent to Obtain Information