Informed Consent for Psychological Assessment/Testing
Welcome to Grandis Evaluation Center, P.C. (GEC). We look forward to working with you, with a goal of understanding abilities, including both strengths and weaknesses, and making recommendations to support improvements in work, school, social, and other areas of life. The following is an outline of important information to know about psychological services provided by GEC. Please ask any questions you may have about the content of this document. If signing electronically, you may direct questions to info@gectesting.com or call our office at either of the numbers listed above. Once signed, this document will represent an agreement between us.
Credentials
All of the psychologists working at GEC hold state licensure through the NC Board of Psychology. They have all received graduate level supervised training and experience to attain this licensure. Our clinicians have a wide variety of experience working in different settings and with different age ranges. Please refer to our website www.GECtesting.com for more information regarding each of our clinicians and their professional expertise.
What is psychological Assessment/Testing?
Psychological assessment/testing (also referred to as psychological evaluation) is a process that consists of a clinical interview, administration of standardized test measures, and completion of self- and/or observer-perspective questionnaires. These activities are often completed in a single appointment, though additional appointments or discussions are sometimes necessary for additional information gathering. Depending on the individual’s concerns and questions to be answered during the evaluation, assessment measures may evaluate any or all of the following areas:
- Cognitive Functioning
- Academic Achievement
- Attention and Executive Functioning
- Emotional, Behavioral, and Personality Processes and Functioning
What is the Process?
All evaluations will consist of a detailed information gathering discussion, typically referred to as a clinical interview. This discussion typically includes relevant social, school, family, medical, and mental health history as well as current psychological symptoms and problems. Standardized test measures and questionnaires are completed. Scoring and interpretation of the test measures can occur before, during, and after the clinical interview. Your clinician will write a comprehensive report outlining information gathered in the initial evaluation as well as interpretation of the test findings and recommendations. The report is typically completed within 2-3 weeks after the initial appointment. A feedback session either in-person or over the phone is part of the evaluation process. This feedback includes explanation of the test findings as well as recommendations to address areas of concern. Any and all questions about the evaluation and its outcomes are welcome. The report will be shared with the examinee (or their guardian) as well as any office or organization for whom a release of information has been signed.
Benefits and Risks
The primary benefits of a psychological evaluation include diagnostic clarification, insight into strengths and weaknesses, a written report to facilitate connection with services in the community or in a school setting, and suggested treatment recommendations to improve weaknesses and maximize strengths. Although most examinees have a positive experience during the evaluation process, there are some risks. Some people may experience discomfort in being evaluated - including but not limited to frustration, anxiety, embarrassment, etc. Clients are welcome to take a break at any point during the evaluation process. It is also possible that evaluation may uncover unexpected symptoms or behaviors that could require additional testing for diagnostic clarification and confirmation. While the evaluation and the corresponding treatment recommendations are based on best practices, you or others may not agree with the clinician’s conclusions or recommendations. It is your decision whether or not to follow through with any or all of the recommendations. If you have positive or negative feedback you would like to provide regarding your evaluation, please contact the owner of GEC - Amanda Hoffman, PsyD at Amanda@GECTesting.com
Fees and Payment
By scheduling an appointment with Grandis Evaluation Center PC, you agree to the following policy regarding cancellations, no-shows, and copayments:
Psychological testing appointments are reserved especially for you and often involve extended time blocks. Please provide as much notice as possible if you need to cancel or reschedule so that we can offer the opening to another patient. Cancellations within 24 hours will be charged a $175 fee. If you miss your appointment without notice, you will be charged a $175 no-show fee. Given the high community need for services and the extensive time blocked for the appointment, not informing us of your need to cancel your appointment will result in an inability to reschedule services with our facility. We understand that emergencies happen and will consider exceptions when appropriate.
If you are using insurance, copays, coinsurance, and deductible amounts are due at the time of service. Insurance verification is completed as a courtesy prior to the appointment, though the information received is not a guarantee - final coverage decisions are made by your insurance company. You are responsible for any balance not covered by insurance. If there is a balance due after insurance processes the claim, we will attempt to notify you of the balance due by written and phone communication. Payment of your full balance is due within 14 days of notification. If payment is not received within 14 days, we will place you onto an unofficial payment plan and charge the payment method on file $150 every 30 days until the full balance is paid. If we are unable to make contact with you after 30 days, we will charge the amount due to the payment method on file. If your amount due exceeds $150, we place you onto an unofficial payment plan and charge the payment method on file $150 every 30 days until the full balance is paid. We understand that unexpected charges are inconvenient and we offer payment options including CareCredit to help with unforeseen expenses.
* Please note that Medicaid does not require a co-pay and fully covers psychological testing services.
Confidentiality
In general, the privacy of all communication between a patient, their parent/guardian (if applicable), and the psychologist you’re working with is protected by law and we can only release information to others with your written permission. There are a few exceptions to this rule that can occur including:
- In some cases, your clinician might find it helpful to consult with other health and mental health professionals (which you are not a patient of) about a case. During a consultation, your clinician will make every effort to avoid revealing any information that may lead to identification (ex. not discussing any information such as name, date of birth, residence, etc.). In these cases, the professionals your clinician may consult with are also legally bound to keep the information confidential. Unless the examinee or parent/guardian objects, your clinician will not tell you that a consultation has occurred except where they deem it relevant to the evaluation, results, recommendations, or this agreement. Any consultations will be noted in the examinee’s clinical record as protected health information (PHI), which is protected by law.
- If the examinee is in imminent danger of harming themselves or another person, your clinician must contact authorities or take whatever steps necessary to prevent harm. In doing so, their actions might require breaking confidentiality.
- If the examinee or parent/guardian shares information that would lead a reasonable person to suspect that a child, elder, or disabled adult is being abused or neglected or has died as the result of maltreatment, your clinician MUST report that information to the appropriate authorities.
- If the examinee becomes the subject of a court proceeding and your clinician receives a court subpoena for the clinical record, psychological evaluation report, or the test measures completed, they may have to break confidentiality by supplying those.
- If the examinee or parent/guardian files a complaint or lawsuit against the clinician, they may disclose relevant information regarding the examinee in order to aid in their defense.
If a situation like one of the above occurs, your clinician will make every effort to discuss it with you before taking any action. Your clinician is legally bound to not disclose anything about you or even that you have been evaluated without your knowledge or written consent. If there are individuals with whom you would like use to share a copy of your evaluation report, please also complete the Release of Information form available for electronic signature or as a PDF on our website.
HIPAA Notice of Privacy Practices
GEC maintains compliance with federal laws and regulations regarding HIPAA compliance and maintenance/protection of protected health information (PHI). To review your rights with regard to PHI information, use, and disclosure, please visit the "Referral Process" tab of our website (www.GECtesting.com) or download/print to PDF using the document preview at the bottom of this page.
Your signature below indicates that you have read the information in this agreement and agree to abide by its terms. With your signature, you are indicating that:
- You have been informed of and understand the type of services to be provided and the foreseeable uses of the information obtained.
- You have asked any questions you may have about the agreement.
- You have been informed of the limits of confidentiality.
- You understand and agree to the payment policies.
- You understand that, if provided a digital copy of the report, you are not permitted to make any changes to the report.
- You understand that you must be honest in answering questions on all
psychological questionnaires, tests, and interviews during this exam. Any
attempt to exaggerate or fabricate symptoms of mental disorders could have
negative consequences for future medical and psychological assessment and services.
- You have received our HIPAA Notice of Privacy Practices.