Supporting Contact Authorization

By adding the person listed above as a supporting contact, I authorize NVOX and the evaluating clinician to contact them for the limited purpose of requesting feedback related to this evaluation.

I understand that contacting this supporting contact may disclose the examinee’s name and the fact that feedback is being requested as part of an attention, ADHD, or related clinical evaluation.

I confirm that I have a reasonable basis to provide this supporting contact’s details and do not believe they would object to being contacted for this purpose.

I understand that this supporting contact’s participation is optional and that they may decline to respond.

If the examinee is a minor, I confirm that I am the parent or legal guardian and authorize this request on their behalf.

Please also make sure we store the timestamp, the user who approved it, the statement version, and the exact text shown at the time of approval.