Clark R. Clipson, Ph.D.
Clipson and Osterloh, APC

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Forms

You may download and print any of the following forms by double-clicking on the name of the form you wish to print.  These forms are only to be used by individuals being evaluated by Dr. Clipson.  Please do not download or use these forms without his express permission.

Adult History Questionnaire

Background History for Parents

Drug and Alcohol History Questionnaire

Learning Disability Questionnaire

Neuropsychological History Questionnaire

Pain Questionnaire

Parental Permission for Child Evaluation Form

Release of Information Form

Sensory-Motor Functioning Form

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