neuropsychological testing consent form

Purpose of Neuropsychological Testing:

Neuropsychological (Cognitive) testing utilizing is designed to assess cognitive functions, including memory, attention, language, problem-solving, and other intellectual abilities. This information helps in diagnosing conditions, planning treatments, and understanding the effects of neurological disorders.

Description of Testing:

The testing may include various tasks such as answering questions, solving problems, and performing memory tasks.
The duration of the testing will vary depending on the selected tests. The typical duration ranges from 18 minutes to 1 hour, although the complete neuropsychological evaluation process may be conducted in one or multiple sessions.

Confidentiality:

All information obtained during the testing is confidential and will be used for diagnostic and treatment purposes.
Results will be shared only with your referring healthcare provider and other professionals involved in your care, with your permission.

Potential Risks and Discomforts:

The testing is performed via computer/tablet in electronic form, is non-invasive, and has minimal risk associated.
Some tasks may be challenging or frustrating. Fatigue or mild stress may occur due to the length and nature of the testing.

Benefits:

The results can help in understanding cognitive strengths and weaknesses.

The information may assist in diagnosing neurological or psychological conditions. Results can aid in developing effective treatment plans and interventions.

Voluntary Participation:

Participation in neuropsychological testing is voluntary.
You may withdraw your consent and discontinue participation at any time without penalty. Declining to participate will not affect your access to other medical care or services.

Costs:

The test is Non-Covered by Insurance and will total $100. This fee is due before the beginning of it. The provider may request additional re-testing up to 6 months after the initial one at no cost. Fee is not refundable.

Consent:

By signing below, you acknowledge that you have read and understood the information provided in this consent form. You consent to participate in the neuropsychological testing and understand that you may withdraw your consent at any time.