Forms

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Shannon E. Taylor PhD PA

Clinical Neuropsychology

IMPORTANT PAPERWORK & FORMS

Please print and complete all forms & bring to your appointment

Background & History - Child

Consent for Treatment - Child

Patient Information - Child

Information for Payment - Child

Release of Information - Child

Consent to Photo - Child

Consent for TeleHealth - Child

Background & History - Adult

Consent for Treatment - Adult

Patient Information - Adult

Release of Information - Adult

Consent to Photo - Adult

Consent for TeleHealth - Adult

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