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BulletNew Client Forms:

If you are a new client to Dr. Max's office please first register online by clicking HERE.

Then please download, print out, read through, and then sign the Patient Agreement Form prior to the first session, which will save time at your first appointment. You should also print out the federally mandated Health Insurance Portability and Accountability Act (HIPAA) Notice Form for your records.  Simply click on the links below to view and print out these forms. Please note, you DO NOT need to print out the forms for the MINISTERIAL ASSESSMENTS, unless you specifically have an appointment with Dr. Max to conduct a psychological evaluation for the ministry. If the client is an adolescent 15 years or older, BOTH the parents and adolescent will need to read and sign these forms. You need Adobe Acrobat Reader to view these forms.

HIPAA Notice Form (downloadable)

Patient Agreement Form 2016 (downloadable)

BulletExisting Client Forms:

The following form may be needed to allow Dr. Max to speak with other people (like physicians, lawyers, school personnel, etc.) about your treatment. You may fill it out, sign it and give it to Dr. Max if you would like him to consult with other people for any reason.

Release of Information Form (downloadable)

BulletPsychological Assessment Client Forms:

If you are ONLY having a psychological assessment completed (including ADHD and LD assessments), you need to complete the HIPAA Notice Form, Patient Agreement Form (linked above), and the Psychological Testing Agreement Form (linked below). If you are having an ADHD and/or LD assessment, please do NOT consume any caffeine, nicotine (cigarettes), alcohol and/or drugs at least 24 hours before your assessment and have a good breakfast and a good night's sleep prior to your appointment and do NOT wear a watch to the appointment. Assessment reports typically take 3-4 weeks to complete. Dr. Max only conducts psychological assessments on Friday mornings because of the large amounts of time assessments take. You should know, it is VERY unusual for insurance companies to pay for psychological assessments and that there are often additional requirements and paperwork needed for your insurance to agree to pay for these services. Please be sure you fully understand the requirements and coverage of your insurance company prior to making an appointment. Dr. Max needs all paperwork before setting an appointment for a psychological evaluation.

Psychological Testing Agreement Form (downloadable)

Ministerial Assessment Client Forms:

If you are getting a psychological evaluation as part of a ministerial/ordination process from Dr. Max, you must first sign the HIPAA Notice Form and Patient Agreement Form (above) AND the Informed Consent Form and the Fee Agreement Form (below) and FAX or mail these forms to Dr. Max. After Dr. Max receives them, he may ask you to take some online assessment tools. In order to take these online assessments, you must have a Login name and a Password, which Dr. Max will provide to you after he receives the forms described above. You must have the Login name and the Password provided to you ready before you begin taking the exams. When you are ready to begin taking the assessments, you can click on the "Begin Testing" button below, which will redirect you to a different website. You will then be asked to enter the Login and Password. If this is your first time at the testing site, you will NOT enter a User ID (leave it blank). If you do not finish taking a particular test before exiting the website, you will be assigned a User ID by the program that you must remember so that you can return to the site and, after entering the Login and Password, you can then enter your User ID to resume taking the test where you left off. Once in the site, select the test (or tests) Dr. Max asked you to take. Read the instructions at the beginning of each test carefully and answer each question the best you can. After completing the test and exiting the website, the results will automatically be sent to Dr. Max. The Strong's Interest Inventory and Myer's Brigg's Type Indicator will take approximately 30 - 45 minutes to take. The CPI 434 will take about 60-90 minutes to take. If you have any problems using the site, please contact Dr. Max directly. If you are ready, you may click on the "Begin Testing" button below.

Informed Consent Form (downloadable for Ministerial Assessments Only)

Fee Agreement Form (downloadable for Ministerial Assessments Only)

Begin Testing

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