Christine Wilkes, child psychologist
psychology, child psychology
about christine, licensed psychologist
forms, fee agreement, release of information, consent to evaluate
contact, Portland Oregon, Pacific Northwest
Please download, print and complete the following paperwork and bring it to our first session.

Forms Available for Download

Consent to Evaluation: Please carefully review and sign this. Please do not hesitate to contact me with any questions.

Fee Agreement: Please complete your insurance information.

Developmental History: Please review and complete this form to provide background information about your child.

Release of Information: Please fill in your child’s name, date of birth and the name and contact information for the person you are giving me permission to release and/or receive information from (such as for school staff and therapists). Please initial all areas that you are authorizing in the disclosure, and sign. If needed, I can sign as the witness on all the forms when we meet.