Forms


Select the appropriate form: 
Minor Intake 
Adult Intake

Welcome (Print and Sign) 
HIPAA(Read)  
HIPAA Signature Page(After Reading the HIPPA Form, please print and sign this page) 
Responsible Party (Print and Fill out) 

Select the appropriate Neurofeedback form:
Evaluation-High School 
Evaluation-Adult 
Evaluation-Child

As soon as you have completed all the forms necessary, please return the forms either by hand or by mail. To return the forms by mail: 
202 A Ave E., Albia, IA 52531



 




 




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