Before televideo meetings, please click on the #1 Combined New
Patient Information form, or use the #2 Televideo consent form
only (for Dr. Azrin or Dr. Millsaps) if you have already filled
out the New Patient Information form.
Please click on the Release to give us a release to contact your
referral doctor, other doctors, or any family/friends you would like
us to be able to speak to:
#1 Combined New
Patient Information, Release of Information, and Televideo consent
Azrin Televideo Consent form only
#2 Dr. Millsaps
Televideo Consent form only
Release of Information Form Only
Please fill out the
ADULT PATIENT INFORMATION
FORM (click here to download it) before the
appointment. Bring the
following to the appointment: the enclosed form, list the exact
names daily dosages and who prescribed medications (or bring bottles
for all current medications), snacks/drinks if needed, glasses /
hearing aids if needed for hearing / reading. Some find the evaluation a
bit tiring, so please be sure patient has had a good meal and a good
night sleep before the evaluation, if possible.
1) The patient will first come
in to the office for an interview for about ONE HOUR OR LESS.
The doctor will spend time with the patient and any significant
people / friends / relatives to get background information. Please
fill out the Adult Patient Information Form before the appointment.
Bring the following to the appointment: the enclosed form, list the
exact names and daily dosages and who prescribed medications (or
bring bottles for all current medications).
2) On another day,
the patient will come in for testing.
The testing usually lasts from 4 to 8
hours, depending on the patientís energy level / abilities. Rest
breaks are given. Some find the evaluation a bit tiring, so please
be sure the patient has had a good meal and a good nights sleep
before the evaluation, if possible. Please bring snacks/drinks if
needed, glasses /hearing aids if needed for hearing/reading.
3) The results will be given
to you on another day, not the day of testing.
The test results will usually be
explained in a follow-up appointment with Dr. Azrin 2-7 days after
the evaluation is completed. If the patient has a followup
with a referral doctor, please schedule that followup at least 1 day
after test results are given.
These assessments are commonly requested for
individuals who have experienced an accident, stroke, or anything
that may change the way the brain works. The evaluation is designed
to assess what changes have occurred and look at what this means to
the patientís life.
Here are a few common situations Dr. Azrin & Millsaps
A person begins to notice a problem with
forgetfulness after suffering a head injury in an
A person is depressed or anxious and their
ability to think has become worse.
An elderly person is experiencing memory
lapses and wants to find out if this is just a normal part of aging
or the sign of a memory problem.
A person has suffered some injury to their
brain, and they may now have difficulty functioning in some areas of
their daily lives.
Your assessment will be conducted by Dr.
Richard L. Azrin or Dr. cheryl@123 Millsaps, Licensed
They have specialized training in understanding how the brain
works and how it affects behavior, thinking, and
The doctors will be assessing specific skills
using a wide range of activities. These skills include
concentration, memory, language, and problem solving. Some of the ways these are
tested include answering questions, remembering certain information
and writing things down.
The neuropsychological assessment does not involve a medical
check-up, or a psychiatric assessment. Assessments are usually of
great value to family, friends, doctors or therapists in helping
them to understand your problems better and providing you with the
you for your time and effort.
Please click here for
directions and to see the map to our