INFO

drdanac@drdanac.com

(818) 705-4305

Physical address: 16055 Ventura Blvd. Ste 1135 Encino, CA 91436

Mailing address: 26500 Agoura Rd. Ste 102-872, Calabasas, CA 91302

CONTACT

FORMS

Child Assessment Forms:

Child Initial History Form

Consent to Test a Child 8-22

Adult Assessment Forms:

Adult Initial History Form

Consent to Test an Adult 8-22

Dependent Adult Forms:

Initial History Dependent 18 + years old

Consent to Test a Dependent Adult 8-22

IEE Evaluation Forms:

Child Initial History Form

Consent for testing – IEE

Gifted Testing Forms:

IQ Testing History Form

Consent for IQ Test 3-5

Consent for IQ Test 6-16

OTHER FORMS & POLICIES

Authorization to Release Information

Abridging a Report

Insurance Reference