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Important Forms for NECCA

 Please download and complete the forms below and bring them to the office on the day of your visit. The HIPAA form is for you to keep, all others need to be signed and returned to the office. In addition, please bring all pertinent educational records, including recent standardized testing, IEPs, and any previous medical or cognitive evaluations.

All fees are due at the time of treatment. Dr. Kelly accepts checks and most major credit cards. While Dr. Kelly does not contract with any insurance companies, she will provide a detailed paid invoice so that you can provide your insurance company the necessary codes for possible reimbursement for out-of-network benefits.