See below to download a PDF of our frequently requested documents and forms. Note these are not available for e-signing.
Please return documents as instructed or by the method most convenient for you.
All forms can be sent to your email to complete and e-sign via Adobe Sign (HIPAA-compliant) upon request. There is an option to download a copy of any agreement after you e-sign.
Paper copies are available at all three locations or by US mail upon request.
Download Adobe Acrobat Reader for free.
Please do not hesitate to contact our office if you have any questions or concerns.
Clinic Policies & Informed Consent (pdf)
DownloadHIPAA Notice (pdf)
DownloadRecord Access Request (pdf)
DownloadRelease of Information Authorization Sending records from CNS (pdf)
DownloadRelease of Information Authorization Sending records to CNS (pdf)
DownloadClient Authorization Revocation (pdf)
DownloadNeuropsychological Evaluation Referral (pdf)
DownloadCredit Card Authorization (pdf)
DownloadDemographic Form (pdf)
DownloadAdult History Form (pdf)
DownloadChild History Form (pdf)
DownloadParent of an Adult Developmental History Form (pdf)
DownloadComplete Neuropsychology Services, Inc.
Ann Arbor - Brighton - Grand Blanc
phone (734) 386-0041 - Fax (734) 480-8870
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