Registration and consent

The 1st section helps me gather your contact information.

The 2nd section explains about fees, confidentiality, and other practical administrative matters.

    Contact info

    When you fill this out, it creates a form, already filled out, that we can discuss, and which you sign at your first session. Doing it here will save us time. If you'd rather use paper, there's a form on my website you can print. If you'd rather do this in person, skip it altogether.
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Must be a number between 1,927 and 2,000
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    What you need to know.

    1. Consent Your signature on this form will be considered legal consent for psychological assessment – interview and testing - with Dr. Grady. You can withdraw consent at any time. 2. Confidentiality All information in assessments will not be disclosed without your consent (verbal or written). The following exceptions apply: a) If your file is ordered by the Court, assessments and clinical notes must be released b) If a child is in need of protection and this becomes obvious during an interview, then the appropriate authorities must be informed. c) If you are feeling suicidal, your doctor, family, or the police may be contacted. d) If you are intending to harm another person, the appropriate authorities must be informed. e) If you have a condition that makes it dangerous for you to continue driving, I must report that.
    This is a required question
    This is a required question
    This is a required question