Below you'll find all the forms and documents needed for your child's evaluation. You can download, print, or share these forms with other caregivers. If you have any questions, please don't hesitate to contact our office.
About Our Practice
Overview of Pediatric Neuropsychology Associates including services offered, our approach, what to expect, and information for referring professionals.
Neuropsychological Evaluation Process Overview
A comprehensive guide for caregivers and providers explaining what to expect during a neuropsychological evaluation, including intake, testing, and feedback stages.
Preparing for Your Child's Neuropsychological Evaluation
Parent guide and checklist with tips for preparing your child, what to bring, and what to expect on evaluation day.
Office Location and Directions
Driving directions from I-95, I-595, and Florida's Turnpike, plus parking details and public transportation options for reaching our Fort Lauderdale office.
Before Scheduling Compliance Checklist
Checklist of forms and documents to review and sign before scheduling your child's evaluation appointment.
After Scheduling Compliance Checklist (Under 13)
Complete checklist of forms and documents to review and sign after scheduling your child's evaluation appointment.
After Scheduling Compliance Checklist (13-17)
Complete checklist of forms and documents to review and sign after scheduling your child's evaluation appointment.
Communication Preferences & Consent
Authorization for communication preferences including email, phone, text, and secure portal messaging.
Consent for Evaluation & Treatment (Under 13)
Required consent form for psychological and neuropsychological evaluation and treatment services.
Consent for Evaluation & Treatment (13-17)
Required consent form for psychological and neuropsychological evaluation and treatment services.
Consent for Telehealth Services
Authorization and consent for receiving services via telehealth/video conferencing platforms.
Informed Consent for Neuropsychological Evaluation (Under 13)
Comprehensive consent form for neuropsychological evaluation including nature, purpose, procedures, risks, and alternatives.
Informed Consent for Neuropsychological Evaluation (13-17)
Comprehensive consent form for neuropsychological evaluation including nature, purpose, procedures, risks, and alternatives.
Confidentiality & Its Limits
Information about confidentiality protections and the circumstances under which information may be disclosed.
Language & Communication Preferences
Indicate your family's language preferences and interpreter needs for appointments and materials.
Notice of Privacy Practices
HIPAA-compliant notice describing how your health information may be used and disclosed, and your privacy rights.
HIPAA Notice of Privacy Practices
Detailed HIPAA notice covering uses and disclosures of protected health information, Florida-specific privacy protections, and your rights.
Patient Bill of Rights
Your rights as a patient including respectful care, confidentiality, informed consent, and non-discrimination.
Respect & Inclusion Policy
Our commitment to providing services in a safe, respectful, and inclusive environment for all individuals.
Social Media & Online Communication Policy
Guidelines for social media use, online interactions, email/text communication, and digital privacy protection.
Client Rights & Responsibilities
Overview of your rights to confidential, professional care and your responsibilities as a client.
PracticeQ Patient Portal Guide for Families
Step-by-step instructions for using our secure patient portal to manage appointments, complete forms, and send messages.
Zoom Visit Preparation Guide for Families
Complete guide for setting up technology, preparing your space, and ensuring a successful virtual appointment.
Good Faith Estimate for Neuropsychological Evaluation
Cost estimate provided in accordance with the No Surprises Act for uninsured or self-pay patients.
Good Faith Estimate for Neurodevelopmental Evaluation
Cost estimate for neurodevelopmental services provided in accordance with the No Surprises Act for uninsured or self-pay patients.
Understanding Fees, Payment, & Financial Responsibility
Complete information about evaluation fees, deposit requirements, payment schedule, and cancellation policy.
Authorization to Release Records & Verify Legal Authority
Authorization form for releasing pediatric records with guardianship verification requirements.
Custody & Legal Decision-Making Information
Attestation form to verify legal authority to consent to services on behalf of a minor.
Authorization to Receive Information
Authorization for our office to receive information about your child from other providers, schools, or agencies.
Authorization to Share Information
Authorization to share your child's information with specified individuals, schools, or providers.
Emergency & Crisis Procedures
Important information about what to do in a mental health emergency, including crisis hotlines and resources.
Emergency Contact & Limited Emergency Information Release
Designate emergency contacts and authorize limited information sharing in urgent situations.
Parent Information Questionnaire
Background questionnaire covering your child's developmental history, medical background, and educational history to help us understand your child.
Child's Symptom History & Course
Parent/caregiver questionnaire about your child's symptom history, triggers, flares, treatments tried, and impact on daily life.
Teacher Input Questionnaire
Questionnaire for teachers to share classroom observations about your child's academic performance, behavior, and social interactions.
How to Share a Concern or Complaint
Information about how to file internal complaints and contact external regulatory agencies if needed.