Forms

This form is required for all neuropsychological, psychological, or ADHD assessments. It should be completed by a referring provider (such as a primary care physician, therapist, psychiatrist, or school staff).

Use this form if you would like us to coordinate care or share your records with another provider, school, or family member. A signed ROI is required before we can release any protected health information.

Need Help? If you’re not sure how to complete this form or who needs to be listed, our staff is happy to assist. Give us a call or stop by during office hours.

Current Clients: If you have an active patient portal account, you can request, sign, and submit an ROI directly through the patient portal for faster processing.