Psychological Assessment AgreementPsychological Assessment Agreement • September 23rd, 2015
I, my child’s parent/legal guardian, understand I have the right not to sign this form. My signature below indicates that I have read and discussed the information written in the Office Policies document. It does not indicate that I am waiving any of my rights. I understand that any of the information in the Office Policies document can be discussed and may be open to change. If at any time during the assessment process I have questions about any of the subjects discussed in the Office Policies document, I can talk with you about them, and you will do your best to answer them. I understand that I have the right to withdraw my consent to testing at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with you before ending it with you.
ContractPsychological Assessment Agreement • October 13th, 2015
This form contains information regarding Dr. Rockett’s practice policies specific to psychological assessment. Is it understood that you have read and reviewed with Dr. Rockett the information contained in the document entitled ‘Practice Policies and Informed Consent for Psychological
AGREEMENT TO PARTICIPATE IN PSYCHOLOGICAL ASSESSMENT AT THE CLINICAL PSYCHOLOGY CENTERPsychological Assessment Agreement • April 4th, 2022
While the CPC is not legally obligated to follow HIPAA regulations, we aspire to do so, because we believe this will improve the quality of the care you receive in the CPC. You should go over the Agreement today with your clinician, and after the clinician has answered any questions you may have about it, you will need to sign the Agreement before services can be provided in the CPC. You can take the Notice home with you, and if, after reading it, you have questions about it, you can ask your clinician at another time. However, your signature on this Agreement verifies that we have given you a copy of the Notice.
PSYCHOLOGICAL ASSESSMENT AGREEMENT AND PLANPsychological Assessment Agreement • April 9th, 2015
This form contains information regarding Dr. Rockett’s practice policies specific to psychological assessment. Is it understood that you have read and reviewed with Dr. Rockett the information contained in the document entitled ‘Practice Policies and Informed Consent for Psychological Services.” The present document serves as supplement to the information contained in the former.
