The patient and provider forms below may be downloaded as PDFs and completed for fax, email, or print. For your convenience, these may also be completed directly in the Patient Portal by creating a new patient account.

Please note: At this time, there is no way for you to upload PDFs or other documents to the Patient Portal.  If you want to send documents to Dr. Sedlak (e.g., Release of Information form, medical records) please send them via email.  Dr. Sedlak can then upload the documents to your patient profile.  Dr. Sedlak uses secure, HIPAA-compliant email software so you can be assured that your information is safe. 

Forms for patients and caregivers:

• Adult Intake Form
• Child Intake Form
• Informed Consent and Privacy Policy
• Release of Information (from Triad Neuropsychology to Other Providers)
• Request for Records (from Other Providers to Triad Neuropsychology)

Forms for providers:

• Referral Form