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NH Portsmouth Neuropsychology Center Adult Neuropsychological Evaluation Informed Consent Form 2020-2025 free printable template

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Portsmouth Neuropsychology Center, LLC 501 Arlington Street; Suite 1F Portsmouth, NH 03801 pH. (603) 4330800 Fax (603) 2972913NOTICE TO CLIENTS AND CONSENT TO NEUROPSYCHOLOGICAL EVALUATION AGREEMENT TO
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How to fill out NH Portsmouth Neuropsychology Center Adult Neuropsychological Evaluation

01
Gather any necessary medical history and documentation.
02
Complete the intake forms provided by the NH Portsmouth Neuropsychology Center.
03
Provide personal information including your name, date of birth, and contact information.
04
Detail any current medications you are taking.
05
Indicate any history of neurological or psychological conditions.
06
List any specific concerns or reasons for the evaluation.
07
Schedule an appointment and prepare for the evaluation session by ensuring you have ample time and a quiet space.

Who needs NH Portsmouth Neuropsychology Center Adult Neuropsychological Evaluation?

01
Individuals experiencing cognitive difficulties or memory issues.
02
Patients with a history of neurological conditions such as strokes or traumatic brain injuries.
03
Those with psychiatric disorders that may impact cognitive functioning.
04
People undergoing treatment for conditions like ADHD or learning disabilities.
05
Individuals seeking a comprehensive understanding of their cognitive strengths and weaknesses.
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It is a comprehensive assessment that evaluates cognitive, emotional, and behavioral functioning in adults to identify potential neuropsychological issues.
Individuals who are experiencing cognitive or emotional difficulties, often referred by healthcare providers, may be required to undergo this evaluation.
Patients typically need to provide personal and medical history, complete questionnaires, and may need assistance from healthcare professionals if required.
The purpose is to assess cognitive abilities, diagnose potential disorders, and guide treatment and rehabilitation plans.
Reportable information includes personal details, medical history, psychological symptoms, cognitive performance data, and any previous evaluations.
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