Sheila C. Johnson Center Forms & Paperwork


Initial Paperwork for an Assessment

Provider Notice of Privacy Practices

Case History

Policies & Consent

 

Initial Paperwork for a Hearing Evaluation or Auditory Processing Evaluation

Provider Notice of Privacy Practices

Auditory Processing Case History - Adult

Auditory Processing Case History - Child

Medication History 

 

Additional Paperwork

Payment Policy

Payment Agreement

Release Form

Application for Reduced Fee