Dana Chidekel, PhD

​A psychological corporation


Testing Forms

Child Assessment forms:               Child Initial History Form 

                                                       Consent to test a child 9-17.pdf

Adult Assessment forms:               Adult Initial History Form

​                                                       Consent to test an adult 9-17.pdf

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

                                                       Consent to test a dependent adult 9-17.pdf

IEE Evaluation forms:                Child Initial History Form

​                                                       Consent for testing - IEE

Gifted Testing Forms                     IQ Testing History Form.pdf

                                                       Consent for IQ Testing.pdf

Other Forms and Policies


Authorization to Release Information: Authorization to Release Information

Abridging a Report: Abridging a Report

Request for Records of Services Provided: Request for Medical Records

Credit Card Authorization: Credit Card Authorization

Request for Additional Services: Request for Additional Services

Waiver of Feedback Session: Waiver of Feedback Session

Services Included in Fee: Services Included in Fee

Consent for Consultation-Psychotherapy: Consent for consultation-psychotherapy.pdf

Consent to Treat a Dependent Adult: Consent to treat a dependent adult 9-17.pdf