Important Forms

If you are scheduled for a neuropsychological evaluation, please review and complete the following forms: Privacy Practice Notice, Neuropsych Consent, Insurance Fee Agreement (if the evaluation will be billed to your insurance), and Intake Form. You can print and bring these with you on the day of your appointment, or you can fax them to us in advance at (855) 249-5320. For all other evaluations, give us a call at (520) 441-4006 if you are unsure which form(s) you require.

To schedule an evaluation, have your medical provider fax our office the following:

• A referral with relevant diagnosis code(s) - see our sample referral for an example of how to use our referral form.

• The most recent clinical office notes and any imaging (or other records) you'd like us to review.

• A demographics sheet that includes the contact and insurance information for the patient.