Psych Evaluation Test Forms Details
PSYCH EVALUATION TEST FORMS PAGE
UCSC Students: Dr. Chambers does not take your insurance. He will take a single case agreement. This may require you calling and working in conjunction with the UCSC insurance department and/or Anthem Blue Cross. Call your insurance company for details.
FORMS for ALL Patients:
Informed Consent Testing 7.29.17 (Required for a Psych Evaluation Test)
HIPAA Word Final 5.9.15 (Required Psych Evaluation Test)
Intake Form 5.15.15 (Optional, HIGHLY Suggested for Children)
Authorization of Release 6.25.15 (For all Releases of Information)
UCSC HARDSHIP LETTER 6.25.15 (For Students Needing Financial Help From the School) *You will need the funds prior to the appointment. It usually takes about 2 weeks.