The tests and materials require a password to install or use.
Please contact Pain Assessment Resources to become an authorized customer and receive a password.
Please print this form out and complete it. Then fax to Pain Assessment Resources at 775-853-9888 or you may mail it to Pain Assessment Resources; 4790 Caughlin Parkway Suite 173; Reno, Nevada 89519.
Name and Degree:
Address:
City:
State:
Zip/Postal Code:
Country:
Email:
Telephone:
Fax:
Highest Degree Earned:
Graduating Institution:
Area of Study:
Year of Studies:
Certification and Licensing (please provide the following information)
License/Certification Number:
Authorizing Agency:
Expiration Date:
For All Purchasers:
I certify that the information contained in this form is accurate. I certify that any test material and/or services which I purchase from Pain Assessment Resources will be used in an ethical and responsible fashion similar to what is outlined in the Standards for Educational and Psychological Tests. I have read and understand the materials describing the PAR test I am ordering and am also familiar with the proper administration and interpretation of the test. In addition, if I am not a qualified mental health professional, I will make every effort to refer patient in need of mental health services (e.g., mood related problems).
