INFO

drdanac@drdanac.com

Physical address: 5000 Parkway Calabasas, Suite 305, Calabasas, CA 91302

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

CONTACT DR. CHIDEKEL

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