Forms

If you are a Patient, when you are ready to be seen for neuropsychological evaluation, please download and print this Intake Form.

If you are a Health Care Professional, and wish to refer a patient for neuropsychological evaluation, please download and print this Referral Form.

We accept Medicare, Medicaid, and many insurances. Please be sure to complete the insurance portion of the form so that we may verify your benefits and let you know prior to your appointment the amount of any out-of-pocket costs.

Once completed, please return the forms:

  • By fax: 505-212-0359
  • By mail: 600 Central Avenue, SE, Suite 221, Albuquerque, NM 87102

E-mail is not a secure medium over which to transmit personal information, and Rio Grande Neuroscience cannot be responsible for the security of information when it is being transmitted over the web. That said, if you still prefer to send your forms via e-mail, you may do so by:

  1. Right-clicking on the Intake Form link
  2. Saving the document to your desktop
  3. Filling in all requested fields
  4. Saving the completed file as RGN Forms – Your Last Name
  5. Attaching to an e-mail to info@riograndeclinic.com

Once the completed forms are received and processed, you will be contacted to make an appointment.