Appointments and Cancellations: Each appointment involves the reservation of time specifically for you. A minimum of 24 hours (1 day) notice is required for re-scheduling or canceling an appointment. The full fee will be charged for appointments missed without such notification and are due and payable by the next visit. 

Insurance companies do not reimburse for missed sessions.

Services: The neuropsychological evaluation is a comprehensive process that includes:

• Completion of the Biographical Questionnaire and self-report measures about your brain-related symptoms and emotional functioning. (Approximately 1 hour)
• An extensive interview (face-to-face or teleconference) during which we discuss your background and current symptoms. The interview includes relevant developmental and psychosocial, school and academic, employment, family, and medical history; and results of any previous psychological, psycho-educational, or neuropsychological testing. (Approximately 2 hours)
• Face-to-face assessment (testing) with standardized tests sensitive to areas of brain function important in everyday life such as attention, concentration, processing speed, mental flexibility, language, visual spatial abilities, memory, and thinking. As appropriate, academic achievement tests (e.g. language, reading, spelling, and math) are given. (Approximately 4 to 6 hours, or more, depending on the referral question and other factors.)
• Feedback about your performance during testing including discussion of your brain-related and emotional strengths and weaknesses; recommendations to guide treatment for your personal, educational or vocational needs; and make relevant recommendations to your other health care provider(s). (Approximately 1.5 to 2 hours)
• A written report. The outcome of neuropsychological evaluation is a written report in which conclusions are made about your overall functioning. The report may include specific recommendations to guide treatment or enhance your overall functioning in everyday life. The conclusions and recommendations are developed by integrating information obtained from the standardized testing, interviews, records and other observations.

 

The neuropsychological evaluation process, including additional time required for scoring, interpreting, and analyzing test results, report writing, and feedback is described in detail in the Consent for Neuropsychological Services.

Services may be billed on days when there is no face-to-face contact.
 

Payment for services rendered: I am obligated to bill your insurance company only if I am a contracted provider. I am a contracted provider for UC SHIP. With this insurance plan you agree to assignment of benefits to Bonnie Connor, PhD. You will be responsible for the $100 deductible not covered by UC SHIP. Psycho-educational testing is billed as neuropsychological testing. If you do not have UC SHIP you are responsible for payment in full for the evaluation.

Initial (required):

 

If you do not have UC SHIP, it is your responsibility to file claims with your insurance company for any and all services provided by Bonnie Connor, PhD, unless I am a contracted provider (see above). If requested, I will provide you with a “superbill” to submit to your insurance company. Because you have paid for the evaluation, any reimbursement from insurance will go directly to you. It is your responsibility to determine whether your insurance company will reimburse you.

Payment: You may pay for the evaluation by check made payable to Dr. Bonnie Connor, or by credit card on my website with the “Pay Now” button.

I have carefully read this agreement and my questions were answered by Bonnie Connor, PhD.