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Neurofeedback and QEEG
928 Broadway, Suite 305, New York, NY 10010
212.807.8690

Merlyn Hurd Ph.D.
Licensed Psychologist and
Certified Neurotherapist

All Forms

For your convenience, here is a list of download-ready forms used frequently in my practice.

Breathing Checklist (87.7 KB)
A form to determine whether your breathing is acceptable to begin treatment
Credit Card Authorization Form (0.1 MB)
The form for credit card authorization.
HIPPA 1 Form (0.1 MB)
A form for HIPPA
Neuroguide Symptom Checklist (0.2 MB)
A checklist to to determine symptom range to determine treatment availability
QEEG Intake Information Form (0.2 MB)
A form for QEEG Intake and Information




NY Neurofeedback and QEEG • Merlyn Hurd Ph.D. • Licensed Psychologist and Certified Neurotherapist
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