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Uhc Psychological Testing Consent Form

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UHC Psychological Testing Consent Form

UHC consent form

Page 1

Please read the following information carefully before signing the consent form.

Email*

Patient Name*

Date of Birth*

Address*

Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

Reason for Referral*

Current Symptoms and Concerns*

10.

Previous Treatment History*

11.

I have read and understand the above information*

Yes

Description:UHC Psychological Testing Consent Form

This UHC Psychological Testing Consent Form is a document that provides information to patients about the psychological testing process and their rights as a patient. The form outlines the purpose of the testing, the types of tests that may be administered, and the potential risks and benefits of the testing. It also includes information about confidentiality, the patient's right to refuse testing, and the patient's right to access their test results. By signing this form, patients give their consent to undergo psychological testing and acknowledge that they have received and understand the information provided.

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