If you are age 18 or older, please fill out this Intake Form and bring this with you to your first appointment.

  • If you have any questions about the form or the questions contained in the form, please feel free to contact us by email or phone and we will be happy to provide guidance in completing the form.

If you are a parent of child age 17 or younger, please fill out this Intake Form and bring this with you to your first appointment.

  • If you have any questions about the form or the questions contained in the form, please feel free to contact us by email or phone and we will be happy to provide guidance in completing the form.

Release of Information

If you would like Silicon Valley Assessment to contact another provider to obtain any records necessary for the evaluation (e.g., medical records or previous neuropsychological reports), please complete the Release of Information Form - Requesting 

If you would like Silicon Valley Assessment to release your report to another provider, family member, or a third party of your choice, please complete the Release of Information Form-Sending.

Please be aware of your rights as a patient to have access to your medical information. Click here to read more about your Patient Rights and HIPAA.