• NEUROPSYCHOLOGICAL TESTING AGREEMENT

  • BEHAVIORAL HEALTH NETWORK

    DR. JOSEPH SCHEMBRI

    5 NORTH MEADOWS ROAD

    MEDFIELD, MA 02052

    Phone: 1-508-246-6493

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  • This is an understanding between BEHAVIORAL HEALTH NETWORK (BHN) testing service and the client named above.

    This agreement covers the cost of neuropsychological Testing between the client and the practice. It is agreed that BHN will perform this testing using all standard and conventional testing methods. The standard battery of tests will include but not be limited to: Neuropsychological Testing; Intelligence Testing; Academic Testing and Personality Testing and will be determined by BHN.

    Please note that if the third-party payor does not reimburse, the client will be responsible for full payment.

    Testing Cost: $2,500.00 to $3,500.00 depending based on specific referral question.

    This service will include a feedback session to review the results of the testing with the tester, including appropriate recommendations and planning for further treatment or academic support.

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  • Deposit Method: (Only for Out of Pocket payors)

    Pay by Check: (Mail check with printed agreement form to the address below.)

    BEHAVIORAL HEALTH NETWORK

    5 North Meadows Road

    Medfield, MA 02052

    Attention: Dr. Schembri

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