The following forms are the basic forms that you will need to complete prior to your scheduled appointment.
- Intake Form – Child
- Intake Form – Adult
- Background Information Form – Child
- Background Information Form – Adult
- Practice Privacy Act
- Informed Consent Form-Testing
- Authorization to Communicate via Email
Please print and complete this form if you would like me to communicate with any other professionals:
Please print and complete this form if you have scheduled a school observation:
Please print and complete this form if you would like Dr. Lurie to automatically recharge your credit card the payments due on the two days of testing and feedback session. The information from your credit card will be collected when you make your initial deposit.