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Bonnie Connor, PhD PAY 22446 PO Box 1216 Davis CA 95617 Davis: 530.750.1700 Walnut Creek: 925.407.4774 F: 800.390.1612 CONSENT FOR NEUROPSYCHOLOGICAL SERVICES This consent form is to request the voluntary
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How to fill out consent for neuropsychological services
How to fill out consent for neuropsychological services:
01
Start by carefully reading the consent form provided by the neuropsychological services provider. It is important to understand the purpose and scope of the services being provided, as well as any potential risks or benefits involved.
02
Fill in your personal information accurately and completely. This may include your full name, date of birth, address, contact information, and any other relevant details required by the provider.
03
Review the specific services mentioned in the consent form and indicate which ones you give consent for. Some common services in neuropsychological assessments may include cognitive testing, behavioral observations, medical record reviews, and psychological interviews.
04
Take note of any limitations or restrictions you wish to include in the consent form. For example, you may want to specify that certain information can only be shared with specific healthcare professionals or organizations.
05
Sign and date the consent form. This demonstrates your acknowledgement and agreement to the terms and conditions outlined in the form. If you have any questions or concerns, it is advisable to seek clarification from the neuropsychological services provider before signing.
Who needs consent for neuropsychological services?
01
Individuals seeking neuropsychological services generally need to provide consent. This may include adults seeking evaluation for themselves or parents/legal guardians providing consent on behalf of minors.
02
In some cases, consent may be required from authorized representatives or designated decision-makers for individuals who are unable to provide consent due to cognitive impairments, such as those with severe dementia or intellectual disabilities.
03
The specific requirements for consent may vary depending on the legal and ethical guidelines of the particular jurisdiction, as well as the policies of the neuropsychological services provider. It is important to inquire with the provider about their specific consent procedures.
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