Please read for important information:

PedNeuropscyhBroch3

WPN-HIPAA

FOR ALL WPN ASSESSMENTS

Please print the following forms, complete and bring to your first office visit: 

Consent for Care

Financial Agreement 

Patient and Family Rights

Release of Information

Registration Form

 FOR NEUROPSYCHOLOGICAL ASSESSMENT  

Please print this form, complete and bring to your first office visit

WPN Neuropsychological History Form

Please print this form, in lieu of the history form, if your child has previously been seen and is returning for a re-evaluation

WPN Re-Evaluation Form

PSYCHOEDUCATIONAL ASSESSMENT FORMS:

Please print and complete this history form, only if you are seeing Dr. Mucha

Psychological History form