Dana Chidekel, PhD

​A psychological corporation


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