New Patient Task List
Thank you for your interest in scheduling an evaluation with The Neuropsychology Center of St. Louis. A neuropsychological evaluation is a time-intensive endeavor, typically requiring 12-20 hour of the clinician's time. As such, each new patient requires a significant amount of coordination between the clinician, patient/family and psychometrician. In order to reduce wait times and increase our ability to offer timely service to new patients, we require a $300 non-refundable deposit in order to secure your appointment. If you decide to not proceed with your evaluation after it has been scheduled and confirmed, this payment is non-refundable. If you decide to proceed with the evaluation, this payment will be deducted from your final balance. We do not hold appointments for more than 24 hours. If you are unable to complete the sections below
Please complete the following tasks in order to be scheduled for your initial appointment.
Once all of the steps have been completed, we will send you an email that will verify the date and time of your initial appointment and provide additional information about your evaluation.
If you have any questions, please contact the office at (314) 324-3800 during normal business hours.
Please complete the following tasks in order to be scheduled for your initial appointment.
Once all of the steps have been completed, we will send you an email that will verify the date and time of your initial appointment and provide additional information about your evaluation.
If you have any questions, please contact the office at (314) 324-3800 during normal business hours.
To be completed within 24 hours of your initial phone contact with our staff in order to secure your appointment date/time:
1. Pay your $300 non-refundable fee in order to secure your appointment by clicking here.
To be completed no later than one week prior to you initial interview appointment date:
1. Download, digitally sign and save your Informed Consent by initialing all of the initial fields on pages 11 and 12, and providing full signature and date on page 14:
| Consent.pdf |
2. Download, digitally sign and save your HIPAA Notification:
| HIPAA.pdf |
3. Download, complete and save the appropriate History Questionnaire (based on the patient's age):
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For Ages 2-11,
use the Child version: |
For Ages 12-18,
use the Adolescent version: |
For Ages 18+,
use the Adult version: |
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4. Upload your completed Consent, HIPAA form and history questionnaire via our Patient Portal here.
5. Upload additional records (if applicable) via our Patient Portal here.
Additional records can include the following:
- Mental health treatment records, including:
- Psychotherapy progress notes
- Progress notes from a treating psychiatrist
- Treatment summary from the patient's current and/or previous mental health provider
- Discharge summary from any psychiatric hospitalization(s)
- Academic records including:
- Report cards
- Academic transcripts
- Standardized test scores
- Current and/or previous IEP/504 documents
- Current work samples (e.g., writing samples, homework samples, etc.)
- Any previous psychological or academic testing reports/records
- Medical records including:
- Imaging reports from any head MRI/CT scans
- Inpatient hospitalization records
- Any other records that could be potentially relevant to the current concerns and history of the patient.