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TEST ONLY FORMS

For your convenience and to save time before your first appointment, we have provided the required forms that you will need to complete for your first appointment. By completing the documents before you arrive, you prevent the need to arrive early for paperwork.

Directions for Electronic-Fill Forms

1. Click on the desired form; it will open in your browser.

2. Fill in the appropriate form fields.

3. Click the print button to print the form.

Note: We recommend that you download/save the forms so you can easily make changes, and then re-print them.
4. Sign the printed forms; bring them with you to your first appointment.

ADULT Clent Forms

1. Cover Letter

2. Consent for Services & Fee

3. Authorization for Scheduling, Billing and Payment Purposes

4. Cancellation Policy

5. PF1000 Notice of Privacy Practices

6. PF2000 Privacy Consent

7. Adult Intake form

8. Notification & Coordination with
Primary Care Physician-Psychiatrist

9. Emergency Contact Authorization

LENS Neurofeedback forms
Adult

Adult Consent form

CNS Questionnaire

Sensitivity Questionnaire

Photonic Stimulator Informed Consent

Emergency Contact Authorization

MINOR (Child/Adolescent) forms

1. Cover Letter

2. Counseling Minors

3. Consent for Services & Fee

4. Authorization for Scheduling, Billing and Payment Purposes

5. Cancellation Policy

6. PF1000 Notice of Privacy Practices

7. PF2000 Privacy Consent

8. Child/Adolescent Intake Form

9. Notification & Coordination with
Primary Care Physician-Psychiatrist

10. Notification & Coordination with Education Professionals
11. Emergency Contact Authorization

LENS Neurofeedback forms
Minor (Child/Adolescent)

Minor/Adolescent Consent form

CNS Questionnaire

Sensitivity Questionnaire

Photonic Stimulator Informed Consent

Emergency Contact Authorization

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