Leah A. McGuire, Ph.D.
Pediatric Neuropsychologist

FORMS:

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Forms for Intake Appointment:

Attached please find forms that should be completed and returned BEFORE your parent intake appointment with Dr. McGuire. Forms may be returned via email (info@leahmcguire.com), mail, or fax (908-753-8089).  GeniusScan is a free application that will allow you to scan and email forms using your phone if you do not have access to a scanner.

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1. Intake Evaluation Form: Attached please find an intake evaluation form (in Word and PDF formats for your convenience).  This provides very helpful details regarding your child's background and current functioning.  You may wish to print and write on this form.  

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Intake Evaluation Form (Microsoft Word)

Intake Evaluation Form (PDF)

 

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2. Signature Page: This document allow us to conduct the evaluation and subsequent treatment.

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Signature Page (Microsoft Word)

Signature Page (PDF)

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3. Telemedicine Informed Consent: This document allows us to conduct the intake and feedback appointments virtually.

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Telemedicine Informed Consent (Microsoft Word)

Telemedicine Informed Consent (PDF)

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4. Educational Overview: This document allows us to better understand your child's performance in each grade level and other relevant academic information.  Please complete one entry for each year of school your child has completed.

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Educational Overview (Microsoft Word)

Educational Overview (PDF)

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5. Other Helpful Documents: Please email or bring a copy of the patient's most recent report card, any previous evaluations (if applicable), and the patient's most recent IEP (if applicable).  Please feel free to reach out with any questions / concerns.

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Forms for Testing Appointment:

It is recommended that your child dress comfortably for testing appointments and pack snacks / lunch.

 

What to Expect During Testing (Microsoft Word)

What to Expect During Testing (PDF)

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