Dana Chidekel, PhD

​A psychological corporation

Forms


Testing Forms


Child Assessment forms:   Child Initial History Form  

                                                Consent to Test a Child


Adult Assessment forms:  Adult Initial History Form

​                                               Consent to Test an Adult.pdf


Dependent Adult forms:  Initial History Dependent 18 + years old.pdf

                                             Consent to Test Dependent Adult


IEE Evaluation forms: Child Initial History Form

​                                       Consent for testing - IEE



Other Forms and Policies

                                                     

Authorization to Release Information form: Authorization to Release Information


Abridging a Report form: Abridging a Report


Request for Records of Services Provided form: Request for Medical Records


Credit Card Authorization form: Credit Card Authorization


Request for Additional Services form: Request for Additional Services


Waiver of Feedback Session form: Waiver of Feedback Session


Services Included in Fee policy: Services Included in Fee


Consent for Psychotherapy form: Consent for Psychotherapy.pdf