Serenity Neuropsychology & Counseling

Melody Snider, Ph.D.

If you are unable to print and complete the required forms prior to your appointment, you will need to complete them at our office. Please arrive a minimum of 1 hour prior to your appointment to allow time to complete the forms.
 
Please be advised if you do not arrive in time to complete your forms prior to your scheduled appointment, we will need to reschedule.  Dr. Snider needs a full 60-90 minutes to do a thorough intake. Please plan accordingly.
 
In the event we need to reschedule your first appointment, please know there is typically a 3-4 week waiting period before we can reschedule your initial appointment.
 
Our forms were generated using Adobe Reader in PDF format.

If you do not have Adobe Reader, click Get Adobe Reader - Serenity Neuropsychology & Counseling to download it free.

Please complete each of the following 4 forms. Be thorough as this information is necessary to provide an appropriate evaluation and follow up treatment.

 (Forms will open in new window)
Serenity Neuropsychology & Counseling Client Psychologist Agreement FormClient-Psychologist Agreement Form

Serenity Neuropsychology & Counseling Patient Registration FormNotice of Privacy Practices

Serenity Neuropsychology & Counseling Health Screening FormClient Registration Form

Serenity Neuropsychology & Counseling Client Psychologist Agreement FormHealth Screening Form

Notice to all clients: Complete the following Release of Information Form if you wish to have your records released to anyone. If you have questions about releasing your records or about how to complete this form, we will be more than happy to assist you at your initial appointment. If you are being referred by a physician, please know your physician typically requests records be sent to them, particularly if you are being referred for psychological or neuropsychological testing.

acrobat reader 50x50Release of Information Form

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