Schedule an Examination
Hello Executive Member! To more quickly process your Independent Psych Eval appointment, please fill out the information below to the best of your ability. Your assigned Veteran Coach will handle the majority of the questions that may be asked by our healthcare professionals looking at your case.
The U.S. Board Certified Psychologists are 100% independent in their review and evaluation and services are provided through Telemedica, LLC. Please ensure you’re being Uncomfortably Vulnerable; when completing this intake form AND during your Psych Eval. Your Psych Eval will be conducted using HIPAA compliant Video-Teleconference software, and the link will be displayed AFTER submission of this form and booking of your appointment date/time. Please tell the Psychologist how your mental health condition(s) are limiting/affecting your work, life, and/or social functioning. You must be open, honest, and truthful at all times. *SPECIAL NOTE!* It’s against federal law to make any false statements or false claims.
This Forensic Psychological Evaluation is being conducted at the request of you and is somewhat different than other psychological services. It is important for you to understand how a forensic evaluation differs from more tradition psychological evaluations.
a) While the results of this evaluation may or may not be helpful to you personally, the goal of this evaluation is to provide information about how you are functioning psychologically to the individual or agency requesting the evaluation. I am a completely impartial evaluator. I cannot guarantee any favorable outcome.
b) You have a legal right to a copy of this report. You will get a copy from me, and can also get it from your attorney or the courts.
c) When you get a draft of my report, I have a legal obligation to change any factual errors in it. For example, if you are 23 and I say you are 43 or 26 or anything wrong, I am required by law to change it.
d) You may not agree or like some parts of your evaluation. That does not mean I have a legal obligation to change those parts if they are factually correct.
e) You have some confidentiality of the evaluation and the results. A copy of it will go in your C-file if you submit this for a Compensation and Pension evaluation. You can give it to anybody else you wish. I cannot give it to anybody else without your permission and do not have any obligation to do so for you.
I will not conduct the evaluation without your signature on this document. You also have the right to stop the evaluation at any time. However, I will not give any partial refund once I start reviewing your medical records.
Because you’re a client of VHV2020, the fee for services is $200 payable to the doctor through PayPal or agreed payment method., and includes the assessment, Disability Benefit Questionnaire (DBQ) write-up + Nexus Statements, transmission by Google Drive drag/drop, and any answers to supplemental questions the VA might have. If you choose to have a Nexus Statement only the fee is $100.
Due to the demand for my services and the need to keep appointments available for as many Veterans as possible, you may be assessed a re-scheduling fee for MISSED appointments.
If you miss your FIRST appointment, there is a $50 rescheduling fee. If you miss your SECOND appointment, there is a $100 rescheduling fee. If you miss two appointments, you will NOT be allowed to schedule a THIRD time.
To complete my evaluation, I will need your medical records (military medical records, VA medical records, and any private medical records). Ask your Veteran Coach at VA Claims Insider if you need assistance.
I affirm by my signature below that I have given the doctors ALL records of relevant physical and mental health records from VA and non-VA sources. These records have been uploaded to my HIPAA compliant Google Drive folder. If you have questions, please contact your Veteran Coach.
I will not do the video-teleconference interview until I have all of your medical/psychological records, the retainer fee, and this signed document.
VHV2020, Inc. DO NOT promise or guarantee results we only offer tools and resources to use for what is required to win you claim.