FORMS
Please reach us at Admin@ipctesting.org if you cannot find an answer to your question.
LEGAL ONBOARDING FORMS (Required)
**The four forms below are required. It is recommended they are completed prior to your first appointment to allow Dr. Moreland to review them.
1. Referral Form (This can be completed by Evaluee or Attorney/Other Party)
2. Consents and Disclosure Forms
3. Release to Speak with an Attorney / Court Agent
4. Intake Form (History Information)
COLLATERAL REQUESTS
Release of Information Form Link: Collateral Release
**Dr. Moreland generally requests records and/or releases to gather the records for any services within the past SEVEN YEARS. You can send these records to us (via email and/or the client portal) or you can complete the above release for each individual/organization you would like us to request these records from on your behalf:
- Primary Care (Medical, Surgical, Labwork, etc.)
- Therapist(s)
- Psychiatrist
- Specialty Medical Care (Speech Therapy, Occupational Therapy, Physical Therapy, Neurology, etc.)
- ALL Previous Evaluations (Psychological / Academic / Neuropsychological Evaluation Reports)
- Educational Records (IEP, 504 Plan, Relevant Formal School Reviews)
NON-LEGAL ONBOARDING FORMS (Required)
**The two forms below are required. It is recommended they are completed prior to your first appointment to allow Dr. Moreland to review them.
1. Intake Form (History Information)
2. Adult Evaluation Consent/Disclosure Forms OR Child / Adolescent Evaluation Consent / Disclosure Forms
COLLATERAL REQUESTS
Release of Information Form Link: Collateral Release
**Dr. Moreland generally requests records and/or releases to gather the records for any services within the past SEVEN YEARS. You can send these records to us (via email and/or the client portal) or you can complete the above release for each individual/organization you would like us to request these records from on your behalf:
- Primary Care (Medical, Surgical, Labwork, etc.)
- Therapist(s)
- Psychiatrist
- Specialty Medical Care (Speech Therapy, Occupational Therapy, Physical Therapy, Neurology, etc.)
- ALL Previous Evaluations (Psychological / Academic / Neuropsychological Evaluation Reports)
- Educational Records (IEP, 504 Plan, Relevant Formal School Reviews)
***CLICK HERE TO DOWLOAD THE PDF GUIDE
If you have specific questions or concerns about the remote evaluation process, don't hesitate to ask the psychologist beforehand.
We offer several convenient options for uploading your records:
- Client Portal: You can use the client portal through Clio. If you have not received an invitation yet please let us know.
- Google Drive Link for Large Uploads: For large uploads or bulk data, we can send you a Google Drive link to securely upload folders and larger data files. Please request this from us if needed.
- Fax: You can fax your records to us at 855-978-1825.
- Email: You may email your records to admin@ipctesting.org. Please note that emailing records is less secure compared to using fax or the client portal.
- Authorization for Record Request: You can authorize Dr. Moreland to request records on your behalf by filling out a release form for each provider or agency. Access the Release Form here: Release Form.
CLIENT PORTAL
Log in to the Client Portal to message our office staff, schedule appointments, sign documents, share documents, and make payments.
This website uses cookies.
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.