What To Bring To Your Appointment

Whether you are coming to CNS for testing or treatment, we need to review records from other doctors, athletic trainers, educators, and therapists. It is your responsibility to work directly with your student-athlete’s school and providers to obtain copies of relevant records. It is also your responsibility to complete required forms (e.g., History Questionnaire, Rating Forms, and Releases of Information.) Prior to your visit, you may have records and forms faxed or mailed to CNS. Alternatively, you may bring records and forms to your appointment. Receiving relevant records and completed forms before your student-athlete’s appointment is preferred, allowing Dr. Ostergaard to review them in preparation for your visit.

A list of questions you need answered

Completed paperwork (e.g., History
Questionnaire, Parent Rating Forms, and Teacher Rating Forms)
HISTORY QUESTIONNAIRE (PDF)

Relevant medical records, such as physicians notes and test findings
(e.g., CT or MRI)

A list of all medications and supplements

Relevant psychiatric records
(e.g., previous psychological or
neuropsychological testing report(s), psychiatrist assessment, or
therapy evaluation)

Relevant school records
(e.g., Individualized Education
Plan (IEP) or 504 Plan)

Signed Releases of Information for each organization you would like a copy of your student-athlete’s report sent
RELEASE OF INFORMATION (PDF)

Paying For Services

What is the cost for testing, treatment, and consultation services?

CNS charges an hourly rate for the time Dr. Ostergaard devotes to testing, treatment, and consultation. The cost of testing and/or treatment will be discussed during the initial consultation, but will be dependent on the problem being assessed and/or treated, the age of your student-athlete, and if previous testing and/or treatment has been completed through the school district or another provider. The cost of consultation services will be dependent on the desired goal and outcome of the consultation, as well as the amount of time devoted to the consultation and preparation.

Will my health care insurance pay for testing and treatment services?

CNS does not bill health insurance companies directly, but can easily provide a receipt for services for you to submit to your insurance carrier. Families may then be reimbursed by their medical insurance, Flexible Spending Accounts, or Health Savings Accounts.

Depending on the referral question and your student-athlete’s medical history, your medical insurance may provide partial or full coverage of testing and/or treatment services. Services considered preventative (i.e., baseline concussion testing) are not typically covered by medical insurance. It is your responsibility to check with your insurance carrier regarding the terms, conditions, and limitations of your insurance policy.

How do I pay for services?

Children’s Neuropsychology Services accepts cash and credit/debit cards. You have several payment options:

  • In Person:  CNS accepts Visa, MasterCard, Discover, and American Express. If paying with cash, exact amounts are needed. Change cannot be provided.
  • Online:  You may make a credit/debit card payment using the link provided with your bill for services.
  • By Telephone:  To pay by phone using your credit/debit card, please call (612) 850-4043.

Full payment is required at the time of the appointment.

Requesting Your Medical Record

CNS ensures your student-athlete’s privacy by releasing their medical record only to people or organizations you have agreed should receive it. If you would like to authorize disclosure of your student-athlete’s medical record, a Release of Information form must be completed and signed.

As a written request, your completed Release of Information:

  • Helps CNS correctly identify the medical information you want to receive.
  • Documents your authority to receive information you are requesting for a student-athlete. Proof of guardianship is required to obtain medical records.
  • Provides CNS with a record of written requests and the medical information we have released.
  • Is necessary to comply with federal and state regulations and laws.

If you have questions about requesting medical records, please call 612-850-4043. Completed Release of Information forms can be faxed to 320-396-1934. You can also mail or deliver in person to:

Children’s Neuropsychology Services
11900 Wayzata Blvd., Suite #132
Minnetonka, MN 55305