Johnson Neuropsychology, PLLC

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    • Insurance Pre-Authorization
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    • Why Am I Going to See a Neuropsychologist?
    • Assessment Services
    • FAA Evals and COGSCREEN-AE
    • What is Clinical Neuropsychology?

Forms

Pilot & Air Traffic Controller Evaluations for the Federal Aviation Administration (FAA)
(COGSCREEN, SSRI, TBI, Stroke/CVA, ADD/ADHD, HIV+, Sleep Apnea, Substance Abuse, Alcohol Abuse, Anxiety, etc.)
Please download and complete the following forms and bring to your appointment:

  1.  Release of Information
  2. Background Information
  3. FAA consent For Services
  4. Payment Policy

Child Evaluation Forms (Ages 4-18 years)
Please download, complete, and bring to your appointment.

1. Consent for Services
2. Payment Policy
3. History: Medical, Social, Behavioral, Emotional
4. Academic Problems Parent-Student Form

Adult Evaluations (Ages 19-59 years)
Please download and complete the following forms and bring them to your appointment:

1. Consent for Services
2. Payment Policy
3. Background Information

Geriatric Evaluations (Ages 60+ years)
Please download and complete the following forms and bring them to your appointment:

1. Consent for Services
2. Payment Policy
3. Background information
4. Release of Information

*Please see HHS.gov for detailed information regarding your privacy rights.

Adult Psychotherapy (Ages 18+ years)
Please download and complete the following forms and bring them to your appointment:

1. Adult Therapy Form
2. Payment Policy

Insurance Pre-Authorization

Contact Us:

751 Hebron Parkway, Suite 240
Lewisville, TX 75057
469-549-4200
469-549-4201 fax
info@johnsonneuro.com
Get Directions

We provide the individualized attention and care you deserve–no “one size fits all” evaluations here. Our evaluations are customized for each individual to identify specific dysfunction that may be responsible for behavior, mood, or thinking problems.

Copyright ©2017 · 751 Hebron Parkway, Suite 240 Lewisville, TX 75057 · 469-549-4200 · info@johnsonneuro.com