Adult Neuropsychological Evaluation Informed Consent Form - Cook 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name and date of birth in the designated fields at the bottom of the form. This personal information is essential for identification purposes.
  3. Read through the sections carefully, including 'Qualifications and Scope of Practice' and 'Confidentiality'. Ensure you understand each component before proceeding.
  4. In the 'Acknowledgment and Acceptance' section, review the statements regarding consent for evaluation. Make sure you are comfortable with all terms outlined.
  5. Sign and date the form where indicated. If someone is signing on your behalf, ensure their relationship to you is noted.
  6. Once completed, save your document. You can easily share it or print it directly from our platform for submission.

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The patient is mentally incapacitated or emotionally fragile. If a doctor knows that his patient is so distressed that he or she will refuse necessary treatment, the doctor may not be required to get the patients informed consent.
The best place to start if you have concerns about your memory or cognition is with your doctor. A referral directly from your medical provider can help facilitate the scheduling process, including authorization for health care insurance coverage.
Consent Consent is required for adult participants over the age of 18 (e.g., program leader, mentor, volunteer) and youth participants over the age of 16 who are competent in making an informed decision of whether or not to participate in the evaluation.
Every psychologist should consider how they can: provide an accessible explanation to the child or young person about their work as a psychologist; offer a clear reason for their possible involvement; provide an opportunity for the child or young person to talk about what working with the psychologist might involve.
Depending on how you plan to gather the data for your evaluation, you may need a participant information sheet and a consent form. You should seek appropriate informed consent from participants where necessary. Consent should be explicit verbal or written.
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Informed consent means telling individuals about your evaluation and asking whether they are willing to participate. In most cases, you will need to prepare an informed consent form to be reviewed and signed by participants prior to their involvement in any part of the evaluation.

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