Forms

FOR PATIENTS: When you are ready to be seen for neuropsychological evaluation, please fill out the Intake Form and email it to us.

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.

E-mail is not a secure medium over which to transmit personal information, and Rio Grande Neuroscience cannot be responsible for the security of information when it is being transmitted over the web. That said, if you still prefer to send your forms via e-mail, you may do so by:

  • Clicking on this intake form link
  • Saving the document to your desktop
  • Filling in all requested fields
  • Saving the completed file as “RGN Forms – Your Last Name” (for example: “RGN Forms – Smith”)
  • Attaching in an e-mail to info@riograndeclinic.com

If you are not comfortable sending your information by email, you may print out the necessary forms and mail them to us at

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

Once the completed forms are received and processed, 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

E-mail is not a secure medium over which to transmit personal information, and Rio Grande Neuroscience cannot be responsible for the security of information when it is being transmitted over the web. That said, if you still prefer to send your forms via e-mail, you may do so by:

  • Clicking on this Referral Form link
  • Saving the document to your desktop
  • Filling in all requested fields
  • Saving the completed file as “RGN Forms – Your Last Name” (for example “RGN Forms – Smith”)
  • Attaching in an e-mail to info@riograndeclinic.com

If you are not comfortable sending your information by email, you may print out the necessary forms and mail them to us

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