CONSENT FORM: ATTENTION TESTING AT DIGNITY BRAIN HEALTH
Thank you for reviewing the information below in regards to your attention testing, and signing this form (see the bottom of the page).
Best wishes,
Omar Sultan Haque, M.D., Ph.D.
Medical Director, Dignity Brain Health
1101 Beacon Street, Suite 8-West, Brookline, MA 02446
617-651-2528 (phone) | 844-733-6150 (fax)
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I hereby consent to engage voluntarily in attention testing at Dignity Brain Health at 1101 Beacon Street, Suite 8W, Brookline, MA 02446. I understand the following information and agree to its guidelines described below:
What is T.O.V.A. Testing?
At Dignity Brain Health, we utilize T.O.V.A., which stands for Test of Variable Attention, to provide objective insights into Attention-Deficit/Hyperactivity Disorder (ADHD). This remarkable tool enables our healthcare professionals to measure critical aspects of attention and inhibitory control. In essence, it assesses a patient's ability to maintain focus and control impulses, offering valuable data on response time, speed, commission, omission, impulsivity, consistency, focus, vigilance, and attention.
What Does the T.O.V.A. Test Involve?
Engage in computer-based test that resembles an interactive video game rather than a clinical assessment. Respond to prompts by simply clicking a button.
How Reliable is the T.O.V.A. Test?
The T.O.V.A. test boasts impressive accuracy rates, identifying 85% of individuals without ADHD, 84% of those with non-hyperactive ADHD, and 90% of individuals with hyperactive ADHD.
How Long Is An Appointment?
60 minutes
What Ages Are Allowed to Get Tested?
Aged 5 and older
Does this test on its own diagnose ADHD?
NO. The TOVA provides objective measures of attention and inhibitory control, which is not the same as diagnosing ADHD or any other disorder of attention. This test must be used in addition to a clinical interview by a licensed and qualified clinician, and other sources of information, to determine whether one has a diagnosis of ADHD, as there are many causes of poor attention that are not due to ADHD.
Does this test on its own make recommendations about ADHD treatment?
NO. The TOVA can provide objective measures of attention and inhibitory control over time, but the judgment about what the scores mean in the context of specific medication use, or other treatment, is dependent on how one’s prescribing clinician interprets the test.
Is this “neuropsychological testing for ADHD”?
NO. Neuropsychological testing is a many hour, multi-day testing procedure. This appointment is for one hour, and only limited to the TOVA test.
Is the Testing Covered by Insurance?
No, stand-alone T.O.V.A. testing is not typically covered by insurance.
What to Expect During Your Appointment?
Your T.O.V.A. testing appointment is typically scheduled for an hour, so please arrive 10 minutes early. You'll be guided by a staff member who will walk you through the process, including a practice test. Subsequently, you'll complete the T.O.V.A. testing. For children and teens, we encourage them to be in the testing room without a parent or guardian to minimize distractions. A trained staff member will be present throughout the test.
What to Expect After Your Appointment?
Following the test, your results will be reviewed, and we will send you a copy of the results for you to share with your treating clinician.
TEST INFORMATION
-The entire appointment time is approximately 60 minutes, for setup, testing, and debriefing.
-The test is performed by sitting in a chair and using a computer and specialized software
-Let the Dignity Brain Health staff conducting the test know what medications, if any, you took today
-Do your best to get into a comfortable position during testing
-Try your best not to fall asleep
-You should not talk during the test unless you are experiencing problems.
-You may discontinue the test at any time and for any reason.
-If you bring family or friends, they will be asked to wait in the waiting room while you complete the test
PREPARATION
To prepare for your test, please do the following to optimize the accuracy of your results:
-Try and get a good night of sleep the night before
-Avoid any non-prescribed drugs and/or alcohol on the day of the test and/or the day before the test
HEALTH RISKS: GENERAL
-This test is painless, and should be painless; there are no known health risks of taking this test
-There are no restrictions on your movement, driving, or activities after the test
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***Our specialized tests are not covered by insurance, and no insurance claims should be filed by us, you, or any third party, and no out of network benefits apply to the services for testing at our clinic***
ELECTRONIC SIGNATURE
With my electronic signature below, I indicate that I have read this form, and I understand the test(s) procedures, possible benefits, and possible risks that I will undertake, and all information described above, and agree to this form’s content and guidelines, and consent to undertake attention testing at 1101 Beacon Street, Suite 8W, Brookline, MA 02446. If I have any questions or clarifications, I will ask them to the clinic staff before my test and/or to the staff performing my test. Knowing the test’s process, nature, possible benefits and possible risks, I consent to participate.