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HOME | ABOUT US | SERVICES | PRODUCTS | |
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Documents
To Complete and Bring to your First Appointment:
Client Policies - Please read each policy and initial in the space that follows each policy. Initialing states that you understand the policy and agree to comply.
Insurance Signature Form - Please read and sign/date at the bottom.
Insurance Procedures - Please read each procedure and initial in the space that follows each procedure. Initialing states that you understand the procedure and agree to comply.
Privacy Practices Acknowledgement Form - Please read the Notice of Privacy Practices and Outpatient Services Contract prior to signing this form.
Notice of Privacy Practices - Please read prior to signing the Privacy Practices Acknowledgement
Outpatient Services Contract - Please read prior to signing the Privacy Practices Acknowledgement
To Prepare for Your Brainwave Analysis
Brainwave Analysis Preparation Guidelines
To Complete and Bring to Your Evaluation
Child & Adolescent Intake Questionnaire - IMPORTANT!!!! The child should complete this form FIRST in one color ink. The parent/gaurdian should complete this form SECOND in a DIFFERENT COLOR INK. Please complete this form as thoroughly as possible. The more thoroughly this questionnaire is completed, the more comprehensive of a report we can provide to you.
Adult Intake Questionnaire - Please complete this form as thoroughly as possible. The more thoroughly you complete this questionnaire, the more comprehensive of a report we can provide to you.
Phoenixville, PA 19460
tel. 610.933.9440 - fax. 610.933.8567
Serving the Tri-State and Greater Philadelphia Area, including: Phoexniville, Collegeville, Royersford, Valley Forge, Norristown, Audubon, Eagleville, Philadelphia, Montgomery County, Chester County, Bucks County, Bala Cynwyd, Elkins Park, Gladwyne, Ardmore, Bryn Mawr, Narberth, Haverford, Rosemont, Havertown, Villanova, Wayne, Malvern, Media...and more.
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