Patient Forms

Our Patient Forms are available to fill out online and submit electronically.

Click on the form below that you need to complete.

1. Acute Concussion Evaluation Scale

2. Adult ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1)

3. Assignment of Benefits

4. Confidential Exchange of Healthcare Information Form

5. Consent for Diagnosis and Treatment

6. Controlled Medication Prescriptions Agreement

7. Eating Questionnaire

8. Epworth Sleepiness Scale

9. Group Counseling Informed Consent

10. Medical Release Form

11. Informed Consent for TMS Treatment

12. Medical Records Request

13. New Patient Registrations Forms - Adult

14. New Patient Registration Forms - Minor

15. Notice of Privacy Practices

16. Office Policies

17. Patient Record of Disclosures

18. Pittsburgh Sleep Quality Index(PSQI)

19. Post-Concussion Scale—Rivermead

20. Referral for Psychiatric Services

21. Screening for BPD

22. Symptom Checklist Before Seeing Counselor

23. Telepsychiatry Informed Consent

24. Informed Consent for Psychiatric Medication During Pregnancy and Breastfeeding

7/24/2024
Excellent mental health care! Jennifer Jordan, psychiatric nurse practitioner, has helped me immensely with her compassion, understanding of my needs and identifying the best medication and tools for my deep depression, anxiety and bi-polar disorder. She doesn't give up and has worked diligently to find new ways to bring me back to life - to my life. Jennifer recommended TMS treatment for my deep depression, which I jumped on. It was a huge commitment for me - 36 treatments. Now, I have one treatment left and am so grateful to Jennifer for pointing me in the TMS direction. Paul Ruberg is exceptional. As administrator of the treatment, he is compassionate and understanding and clearly loves his work. Paul has explained the process in lay terms. In every session, he has made sure that I've been comfortable (even made sure I had blanket), and he has monitored my progress carefully and meticulously. Thanks to Jennifer and Paul, I am a different person today. I'm "back" - back in my body. The real me that had been buried for so long with anxiety and depression has been rediscovered. I'm motivated, interested and engaged in life again, especially with family and friends. I laugh a lot and I laugh hard, from down deep in my belly. I am sleeping better than I can remember - 7 to 8 hours each night as opposed to cat naps that totaled 4 or so hours before treatment. Both Jennifer and Paul have gone over and above for me. When there was a family mental health crisis, they dug in quickly and provided guidance and information that included a list of specific mental health facilities in another part of the state to go to for help. I am forever grateful to Jennifer and Paul and highly recommend their mental health care.

3/12/24
The first provider I saw ended up leaving the practice and the suggested I start seeing Camtran Huynh. She is the best! I saw her for medication management and she also helped to calm me down and provide better coping mechanisms when feeling like my anxiety was unbearable. Highly recommended choosing Camtran as your provider.

2/12/24
I saw Shalini Jain last week for my adolescent son at her office and had a great visit. She listened to how he was feeling and was very empathetic. My son hates going to the doctors but Shalini made it a very pleasant experience vs other doctors. Shalini asked him questions to draw out his true feelings, as adolescents don't always know how to articulate their feelings. I recommend Shalini to anyone that needs help with their adolescent in the Psychiatry field.

2/8/24
I have been impressed with the quality therapeutic care I have been receiving and continue to receive. My therapist Laurieanne Abernathy is very professional, patient and allow me to freely express myself to get an understanding of where am at in the moment. It's all virtual, but on video which gives it a bit of that personal feel. She provides, guidelines on approaching and responding to situation in my relation.

1/8/24
The care at Neuropsych is fantastic. I have been very impressed by the providers the center has assigned me. The providers are organized, caring, and compassionate. Whenever I make a call to change appointments or leave a note for a doctor, the office calls me back and helps get me the assistance I need. I would highly recommend Neuropsych Wellness.

11/20/23
I have been with this group for about a year now. I have had nothing but fantastic care from all 3 providers that I have seen. I cannot recommend Ceresa Gonzales enough for therapy - she is absolutely fantastic. She is extremely experienced and knowledgeable, as well as being compassionate and dedicated. It is extremely hard to find good mental healthcare, and I feel very lucky that I discovered this practice.

11/7/23
I followed Diane Osborne to this practice! She has provided resources and strategies, treated me with appropriate therapy, discussed my goals for each session and held me accountable for the work I identified as my goal between appointments. She is an amazing person and therapist! She has helped me find peace and live in the present! I truly don't know what I would have done without her! Good luck trying to get an appt with her-they fill up quickly!

9/19/24
This place provides a number of great services. I receive talk therapy, my prescriptions, and TMS treatments from Neuropsych. All of which have proven to be very effective. The staff are very friendly and easy to communicate with. My concerns always feel heard, and the results have been increasingly positive with every visit. I have done around 25 sessions of the TMS so far. My anxiety and panic are at an all-time low, my mood has been steadily adjusting to be more positive, and the experience itself is very easy. With the help of this treatment, and the wonderful people who work there, we have managed to all but fully replace my medication with a process that puts me more at ease.I plan to continue my treatment there for as long as they will have me.

5/25/2024
Best experience with professionals I've ever had and I've experienced many medical care centers but none takes the cake like neuropsych and their experience. They take care of you and take their time getting to know you to reach the best resolution to your medical needs. Very accepting, Informative and timely when needing support with pharmacies

5/8/24
I highly recommend this place. Front desk is amazing they are very kind and caring. Craig is an amazing therapist and very caring and understanding. He has helped me out a lot with ways of coping with things and has great advice. Also Simrit is absolutely wonderful med provider. She really listens to your concerns and needs and is very understanding. She definitely shows a big passion for the work she does. Anytime I have questions or concerns she gets back to me very quickly. I highly recommend them. They always make you feel calm and it’s easy to open up to them there, how understanding and caring they are.

5/9/24
I have been seeing Dr. Raja for a few months now and she is so thorough, so determined to help me find the perfect medication that works for me. She is very kind, attentive, compassionate, responsive, and always finds time for me. I highly recommend Dr. Raja!

4/3/24
I have been seeing Nurse Practitioner Suzanne Cox for several years now and am extremely happy with my treatment and experience. She is patient, attentive, knowledgeable, and truly cares. She really takes the time to listen to my concerns and addresses each of my worries thoughtfully. I feel very lucky to be a patient of hers due to her compassion and expertise. I know I am in good hands and feel comfortable and confident that I am receiving the best care with her. Additionally, I would like to recognize Daniela Rodriguez, the Insurance/ Prior Authorization Specialist, as someone who has also had a positive impact on my experience. Her diligence in working with my insurance and helping me find ways to afford my medication is extremely appreciated. I do not know how I would be able to afford my medication if it were not for her hard work and assistance and I am so thankful.

5/8/24
I highly recommend this place. Front desk is amazing they are very kind and caring. Craig is an amazing therapist and very caring and understanding. He has helped me out a lot with ways of coping with things and has great advice. Also Simrit is absolutely wonderful med provider. She really listens to your concerns and needs and is very understanding. She definitely shows a big passion for the work she does. Anytime I have questions or concerns she gets back to me very quickly. I highly recommend them. They always make you feel calm and it’s easy to open up to them there, how understanding and caring they are.

Neuropsych Wellness Center Reviews & Testimonials