Forms

FOR PATIENTS:

When you are ready to be seen for neuropsychological evaluation, please fill out the Intake Form and fax or mail to us:

  • By fax: 505-212-0359
  • By mail: 600 Central Avenue, SE, Suite 221, Albuquerque, NM 8710

We accept Medicare, Medicaid, and many insurances. Please be sure to complete the insurance portion of the form so that we may verify your benefits and let you know prior to your appointment the amount of any out-of-pocket costs.

Once the completed forms are received and processed and your insurance is verified, you will be contacted to make an appointment.


FOR HEALTHCARE PROFESSIONALS:

If you are a Health Care Professional, and wish to refer a patient for neuropsychological evaluation, please download and print this Referral Form and fax or mail to us at:

  • By fax: 505-212-0359
  • By mail: 600 Central Avenue, SE, Suite 221, Albuquerque, NM 8710