Rossetti Neuropsychological Assessment & Consultation

Who would be receiving care?

Someone else

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Client Preferences

Is there anything else that the practitioner needs to know?

For example: what you'd like to focus on, fee questions, etc.

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Do you consent to the use of AI in the delivery of your care?

Your clinician may use AI tools (such as to generate an intake summary) to support your care. Your information is protected under HIPAA and anything generated by AI is always reviewed by your clinician. AI does not make decisions about your care. You can withdraw this consent at any time by contacting your provider without it impacting the care you receive.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.