New Client Forms

We ask that you arrive 15 minutes early to your first appointment to fill out new client forms.
If you prefer, you may print out the necessary forms and fill them out in advance to avoid the need to arrive early.

For your first appointment with us (INITIAL CONSULT), please fill out:

• Client Information
• Quick Assessment
• Symptom Priority
• Personal History, either the ADULT or CHILD (under 18 years old) version, as appropriate
• Receipt of Notice of Privacy Practices

Note: This receipt confirms that you have received “NOTICE of Privacy Practices.” You do not need to print that out to give to us; it is made available for your information only. We also have paper copies of the Notice of Privacy Practices in our office that we can give to you

For a QEEG BRAINMAP, please fill out:

• QEEG Prep Information
• QEEG Recording Data (as much as you can fill out)
• EEG Screening

Other Forms:

• Authorization to Release Information If applicable, you may choose to authorize communication, such as sending your records, or discussion of your health information, between BiofeedbackWORKS and other health care providers who are treating or have treated you.