Serenity Neuropsychology, PLLC

Melody Snider, PhD

If you are unable to print and complete the forms prior to your appointment, we will need you to complete them at our office. Please leave a message indicating this need and arrive a minimum of 75 minutes prior to your appointment to allow time.
 
Please be advised, if your forms are not completed by the time your appointment is scheduled to begin, we will need to reschedule. Dr. Snider needs approximately 120 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 4-5 week waiting period before we will be able to see you. This time frame varies depending on the time of the year and Dr. Snider's schedule.
 
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 forms. Be thorough as this information is necessary to provide 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

Serenity Neuropsychology & Counseling Client Psychologist Agreement FormCOVID-19 Informed Consent for In Person Treatment

Notice to all clients: Complete the following Authorization/Release Form if you wish to have your records released to or obtained from 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 50x50Authorization/Release Form

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