Forms You Will Need

FORMS

1 – Client Information – fill out as thoroughly as possible – ALL CLIENTS

2 – Informed Consent – read and sign ALL CLIENTS

3 – NPP form – read and keep for your files

4 – NPP Consent form – read and sign – ONLY IF YOUʻRE USING INSURANCE

5 – Credit Card Information – ALL CLIENTS

6 – Consent for Neurofeedback (NF) – ONLY IF YOU ARE DOING NF

7 – Neurofeedback Cash Rates – read and sign – ONLY IF YOUʻRE PAYING CASH FOR NF

8 – Consent to treatment of adolescent – TO BE FILLED OUT BY PARENT/GUARDIAN

9 – Release of Information – ONLY IF YOU WANT ME TO SHARE WITH YOUR DOCTOR

Mahalo!

Click on a file to download.

1 - Client Information - fill out as thoroughly as possible (pdf)

2 - Informed Consent - read and sign (pdf)

3 - NPP Form - read and keep for your files (pdf)

4 - NPP Consent Form - read and sign (pdf)

5 - Credit Card Information - fill out (pdf)

6 - Consent for Neurofeedback - read and sign (pdf)

7 -Neurofeedback Cash Rates 2026-2027 Read and sign if youʻre paying cash (pdf)

8 - Consent to Treatment Adolescent - only if you are the parent/guardian of a minor client (pdf)

9 - Release of Information - fill this out and sign if you want me to confer with doctor or family (pdf)