Most of the common questions we receive are answered in these FAQ, organized by general topic. We are happy to answer additional questions by phone or in writing – reach out by telephone, email info@brainhealthpllc.com, or complete our Contact Form here.

General Policies

We schedule most appointments Monday through Thursday 9:00-5:00 and Friday 9:00-1:00, with some evening availability on a limited basis. Concierge services are provided on weekends as our schedule allows. Due to the nature of the services we provide, we do not provide routine on-call support or after hours monitoring of voice mail, email, or portal messaging. We do make every effort to respond to calls and Portal messages within 2 business days, excluding holidays. In case of emergency, call 911 or go to the nearest emergency room.
It depends on the nature of the services you're requesting. Concussion appointments are usually scheduled fairly promptly, and within a couple of business days for acute (very recent) injuries. More chronic concussion-related and sleep-related appointments can usually be scheduled within a few weeks. We aim to schedule intakes for more comprehensive evaluation appointments fairly quickly, and within a few weeks if possible, since some individuals may fare better with symptom-specific interventions before (or instead of) completing more lengthy evaluations. We also want to allow you sufficient time to collect the records we like to review as part of our comprehensive evaluations. Our goal is to schedule all testing within 2-3 months (presuming all records are provided promptly) with staff to be added as our waitlist grows or sacrificing quality or depth for expediency. Ultimately, our clients and community are not well- served by long wait lists. Know, too, that the more quickly clients can collect all requested records, the more quickly their testing appointment(s) can be scheduled.
Not for most clients. Due to poor reimbursement rates, high overhead costs, and significant limitations on the nature and depth of work most insurance companies will allow, we are largely a self-pay practice. Since we know that this can make quality care less accessible to some, we hope to add group interventions and sliding-scale services in the future as our Charlotte-based practice grows. We do provide superbills for self-pay clients to submit to insurance companies if eligible for out-of-network reimbursement. We accept payment via credit, debit, and HSA cards, and Zelle and ACH transfer. Dr. Shapiro will accept insurance only for Iowa and Nebraska residents with BCBS that she can process through Wellmark/Blue Cross Blue Shield of Iowa, but you will need to verify your eligibility for coverage.
Our consent forms provide detailed information about fees and we are happy to speak with you about them prior to scheduling appointments since fees vary across services. We will provide you with a written Good Faith Estimate of expected charges at the time the initial appointment is scheduled if you do not plan to submit to insurance for reimbursement. In general we charge a flat fee for “standard” comprehensive evaluations, with an hourly rate for all other services and brief evaluations.

You will need to contact your insurance company to get answers specific to your plan and contract in order to verify coverage or to determine out-of-network benefits.

We make every reasonable effort to safeguard your privacy with use of a HIPAA-compliant Electronic Health Record (EHR) system integrated with secure payment processing and telehealth platform. We use our EHR system (IntakeQ) and its Client Portal, rather than email, for routine communications. Our EHR can send appointment reminders by text or email at your request, but we do not respond to text messages sent to the office phone number. Links to standardized rating scales are emailed directly to the recipient from test publishers’ HIPAA-compliant websites. Our consent forms have more information about electronic security and privacy.

Yes! We also test for functional challenges associated with medical and neurological disorders.

Not necessarily. For example, the breadth of Dr. Shapiro’s target client population has expanded along with her clinical skills and areas of expertise over decades of clinical work. We provide routine (neuro)psychological testing to children, adolescents, and young adults. Adult ADHD evaluation referrals are accepted on a case-by-case basis. Concussion management and sleep-related services are provided across the lifespan up to Medicare-eligible populations as medical and neurocognitive challenges
associated with aging fall outside our scope of training and expertise.

In most cases yes, and especially for an initial appointment. Please discuss this with the Psychologist in advance. We typically want parents present for at least part of the initial appointment to help provide a context for the current concerns and/or to facilitate implementation of follow-up, but it also depends on the reasons for which you are seeking care. Note, too, that parents and their children can log in to the appointment from different locations.

Reach out to us by phone or email, or by completing the brief Contact form on the website. A member of our team will follow-up to schedule an appointment or brief consult and to answer any questions you may have. We are happy to schedule a brief call with Dr. Shapiro or anyone else prior to scheduling if you are unsure of how best to proceed or if we can best meet your needs. If we can’t, we are happy to provide referrals.

Most states require licensure in the state in which the client is located at the time of services. Some states allow some limited practice by psychologists licensed in other states, while others require a full application for licensure in order to provide services to someone in that state. Dr. Shapiro has a full and unrestricted license to practice psychology in person and via telehealth in GA, IA, NC, and NE. She also holds APIT authorization to provide unlimited telehealth services and limited in-person services in 40+ states under PSYPACT, an interstate compact. For the most updated listing of participating states, click here.

It depends on the questions you’re asking, or the concerns prompting you to reach out to someone. Just as a nurse practitioner can provide good medical care for some medical disorders, some mental health professionals without doctoral-level training can provide good care, too. Psychiatrists are medical doctors with the same breadth and depth of training as a psychologist – also a doctor – but in the field of medicine. They explore medical / physiological bases of cognitive, emotional, or behavioral difficulties and rely primarily on medical management of disorders (prescribing). Although some psychiatrists obtain additional training in psychotherapy, it is not typically of  comparable breadth and depth as compared to masters- or doctoral-level psychotherapists like counselors or psychologists.

Most doctoral-level (PhD or PsyD) psychologists have 2-3 times more years of coursework and supervised pre-degree clinical training than masters-level providers, with additional post-doctoral fellowship training as well. Even so, a counselor who has chosen to specialize in one particular skill or service could ultimately have more training and expertise in that skill or service than a more broadly trained doctoral-level psychologist! Thus, it is important to ask what kind of experience and training a given provider has for your referral concerns, since the nature and level of the degree doesn’t always provide a complete picture. When it comes to psychological testing, you should look for someone who has had multiple classes in the science of testing (psychometrics) and assessment itself, in addition to months of dedicated, supervised test administration, interpretation, and report-writing.


If you have immediate access to an Athletic Trainer or sideline physician, see them NOW If not, consult with your Primary Care Provider (PCP) or on-call doctor or nurse, or visit Urgent Care or an Emergency Room (ER). See our Concussions page for signs suggesting that a more serious injury may have occurred and that warrants an ER visit. If you’re not sure, go anyway to be safe!

Nope! Most people diagnosed with a concussion do not “pass out” or “black out” (lose consciousness). One of the biggest problems in treating concussions is the absence of recognition and identification of the injury. Look here for a brief definition of what a concussion is, and common signs and symptoms. Sometimes, the only symptom after a hard direct or indirect hit is that the person “just doesn’t feel right” – if unsure, allow evaluation by a trained professional before allowing return to sports with risk of contact to the head. Returning to sport prior to complete recovery can trigger more serious, and sometimes (albeit rarely) life-threatening brain injury.

Sports Neuropsychologists are doctoral level health care professionals – doctors – who have more specialized training in how the brain functions than any other kind of doctor. Not only can concussions affect physical functioning – the symptoms that your medical doctor or physical therapist will assess and may treat – concussions also affect all the aspects of functioning that sports neuropsychologists are trained to evaluate and manage – thinking (attention/memory), behaviors, emotions, and sleep. Thus, sports neuropsychologists have unique skills to provide individualized care to help individuals recover from concussion quickly and safely and return to optimal performance. Since concussions are a different kind of brain injury than a structural injury caused by a tumor, stroke, or penetrating object, not all neuropsychologists have the additional, specialized training needed for appropriate concussion evaluation and management, and especially within the context of sports-related injuries.
No, you’d still want to see a sports neuropsychologist – while knowledge of sports culture and common mechanisms of injury is invaluable for managing sports-related concussions, the mechanisms of injury and general injury-management principles are the same regardless of where or how the concussive injury occurred.
A concussion – a metabolic injury to the brain – affects our thinking, sleep, emotions, behaviors, and physical functioning. Since it affects functioning in so many different ways, there isn't any one doctor or specialist who has enough training to effectively treat all of those areas – it takes a team. Having a team member who has years of training in how the brain works – and how to manage brain injuries behaviorally – is key to recovery and especially when recovery is delayed or when individuals present with known risk factors associated with longer recoveries.
Sports neuropsychologists are experts in understanding brain-behavior relationships and how an injury to the brain – and its symptoms – affects functioning in all aspects of life. We don't need computerized tests to help us to understand, assess, and treat your injury because we have many other tools for that, and we also know that those tests are not always helpful, nor do they tell us all we need to know.

Yes you can – but it doesn’t mean that you should, and you certainly shouldn’t take them at home alone on your own time and in your own way! Without appropriate conditions, those test results may not be very reliable or valid. And, you want to be sure the person interpreting the testing has appropriate training.

Just as you wouldn’t ask a podiatrist to read a mammogram, you wouldn’t want someone without the appropriate degree and training giving and interpreting tests measuring brain functioning. A weekend workshop isn’t a substitute for 6-8 years of training, and there are no good shortcuts.

Neuropsychologists are often regarded as testing experts, and we have many tools to choose from. Common computerized concussion tests are just one tool for determining if you’re 100% back to your pre- injury functioning, but those tests also have drawbacks and there’s no such thing as a “passing score.” When needed, Dr. Shapiro can administer some tests via telehealth or in-person, assist your local Athletic Trainer or physician with interpretation, or refer you to someone else. Working as a team is essential.

Neuropsychological testing for concussions is not nearly as extensive as “traditional” neuropsychological testing, since functioning is expected to change rapidly over time. Even in cases of chronic or persistent post-concussion symptoms, more than 1-2 hours of formal testing is rarely needed, with evaluations typically including extensive clinical interviewing and symptom assessment, with some oculomotor and/or vestibular screening.

Yes…and no! Everyone recovers at their own rate, but recovery should take days or weeks, not months. Recovery should continue to progress quickly and when it doesn’t, we screen for barriers to recovery and known risk factors for prolonged recovery. A standard 20- or 40-minute medical exam is not going to allow enough time, or yield the information that is needed, to expedite recovery. We provide individualized recommendations for supports in home, classroom, and workplace to help manage symptoms in a way that allows clients to return to life while facilitating recovery. When needed, we refer to related providers in your area with the right training and specialized skills to help you, too.

In most cases, no more than a couple of days, tops. Many doctors will recommend a slower return to school or work because going back to the regular schedule can make people feel worse. They do the best they can, but many just don't have the time, or the training of a Sports Neuropsychologist, to develop the individualized Accommodations Plans and Care Plans that can help people return to (modified) normal activities without making symptoms worse.

Again, that’s one of the roles of the Sports Neuropsychologist – to work with you to develop an individualized Care Plan that allows a gradual resumption of daily routines, with short-term adjustments to minimize the symptom triggers that prolong recovery.

What does "rest" mean? And why would anyone tell you to stop using your cell phone or computer? Rather, we help clients understand what, exactly, a concussion is, and how to modify activities at home, work, and classroom, to minimize symptom triggers. We focus on what matters most to you and things you can DO instead of emphasizing what NOT to do, to help you get better faster. Rest doesn't mean doing nothing, and screen use doesn't have to derail recovery!

Everyone recovers at their own rate because of all the factors that can affect symptoms and recovery. Most healthy individuals recover fully in a few weeks. If recovery seems slow, is taking longer, or you have a history of anxiety, depression, learning or attention problems, poor sleep, prior concussions, dizziness,
migraine or other chronic pain, you want a sports neuropsychologist involved to help manage those risk factors associated with longer recoveries. Sooner vs. later never hurts, as we can usually help speed recovery at any age or stage but work with Sports Neuropsychology is not always needed for everyone.

Many doctors recommend that, but just as a medical doctor decides what kinds of tests – like blood tests or imaging, for example – is needed to evaluate an injury or illness, our Sports Neuropsychologist decides what kind of testing or evaluation is needed for her clients. We use many sources of information to evaluate functioning, but we do not always need hours and hours of the traditional neuropsychological testing that your doctor may be thinking of, either. It all starts with intake questionnaires and an initial 1-2 hour initial evaluation – usually via telehealth. From there our providers work with clients and related providers to determine the best next steps.

International guidelines for management of sports-related concussions have not recommended widespread baseline testing for years, though many teams, schools, and parent groups think it's important, thanks to strong marketing efforts from for-profit test publishers, marketing strategists, and related healthcare providers who are sold on weekend workshops and given certificates of completion. That said, baseline testing is used routinely for NCAA and professional athletes. It can be useful for some people when it is administered correctly. Dr. Shapiro is happy to meet and discuss this with you, and to consult with your Athletic Trainer, Coach, Athletic Director, or team to help you decide if it may be helpful and, if so, what kind of testing would be useful. Here, too, you want to be sure that whatever tests are chosen are developed for this purpose, and with the target age range to whom it will be administered. There are also other kinds of tests that Athletic Trainers and Physical Therapists are well-trained to administer – other than computerized cognitive tests – that can also screen for pre-season risk factors like poor balance or oculomotor functioning that they can proactively address to minimize injury risk.

Current research indicates that active recoveries are best – that is, mild to moderate levels of physical activity that do not trigger a significant worsening of symptoms, as long as there is no risk of contact or reinjury. Sometimes this is challenging for schools in states in which students are prohibited from returning to sports until recovery is complete, but a well-trained Sports Neuropsychologist can work with school staff – nurses, coaches, and/or Athletic Trainer – to devise a reasonable and safe rehabilitation
plan while recovery is ongoing.

There is no return to sport until the Return-to-Learn is complete, but experts have long recognized the importance of mild physical activity to expedite recovery while the Return-to-Learn is ongoing.

No, it’s not. Continued headaches suggest that recovery is not complete.


Behavioral Sleep Medicine focuses on the evaluation and treatment of sleep disorders by addressing behavioral, psychological, and physiological factors that interfere with sleep. This can include treatment of insomnia, childhood bedtime problems, determining optimal sleep schedules for shift-workers and individuals who frequently travel across time zones, acclimation to CPAP/BiPAP, and more.
Insomnia is defined as difficulties falling asleep, staying asleep, and/or waking up too early, for 3 months or more and when given sufficient opportunity for sleep, and with significant functional challenges or symptoms associated with insufficient or disrupted sleep.

While some people have “never been good sleepers,” others are ok until some event (such as stress, depression, pain, illness, etc.) triggers insomnia. Disrupted sleep, in turn, can make those things worse.

Research strongly indicates that not only can treatment improve sleep anyway, the improvements to sleep can help reduce those other symptoms.

Not necessarily! Yes, there are sleep-related changes as we go through different ages and stages of life, but it is not unreasonable to expect a good night of solid sleep throughout most of the lifespan.
There's a very strong, well established evidence base to show that cognitive and behavioral strategies – helping to educate, or change beliefs about sleep, and to change sleep-related behaviors – work well for just about everyone. Initial screening (intake) helps to define that more precisely and to be sure that Dr. Shapiro is a good fit for you and your particular sleep-related needs and challenges. If additional, or different referrals are needed, Dr. Shapiro is happy to assist with that.
The American Academy of Sleep Medicine (AASM) and other organizations strongly recommend CBTi (Cognitive Behavior Therapy for Insomnia) as the most effective treatment for insomnia. Medications like Ambien, Lunesta, and more – that Dr. Shapiro does not prescribe – are intended for short-term use and do not provide a cure. CBTi is usually 5-8 sessions that includes education and individualized recommendations to gradually change sleep habits and other related factors.

The National Sleep Foundation offers good information about how much sleep most people need at different ages and stages of life. There are a variety of other factors that can affect sleep need as well. The risks of insufficient sleep – and how insomnia can affect mental and physical health – are, nonetheless, much greater than most realize. Insufficient sleep has been characterized as a public health crisis, and the incremental healthcare costs associated with sleep disorders are surprisingly quite high.

Dr. Shapiro will begin with a developmental history and intake with parents, only. Sometimes she will meet with children in-person at a subsequent appointment, and sometimes she just provides consultation to parents on strategies that slowly and systematically adjust sleep-related routines.
Call, email, or complete our Contact Form and we can call you to schedule an appointment or a brief phone call with Dr. Shapiro if you are unsure and want to speak with her briefly before scheduling. If you would like to schedule an initial consultation, we will send intake forms to complete and return prior to an initial video conference. Some people benefit from just 1 or 2 consultations, with insomnia treatment typically 4-8 sessions. There's no one-size-fits-all.


Psychoeducational testing focuses on learning-related questions and is usually not covered by health insurance in-network or out-of-network. School psychologists licensed to work only in schools, or persons with educational degrees, might examine just academic skill levels, whereas licensed psychologists can also include measures of ability and formally diagnose learning disabilities. Psychoeducational evaluations typically focus on how a student is functioning compared to age-peers, but not as consistently
on the why.

Psychological testing is conducted by a licensed doctoral-level psychologist with years of training comparable in length and depth to that of a medical doctor. Psychological testing can diagnose and identify psychiatric and developmental disorders such as anxiety, depression, ADHD, and autism spectrum disorders. Recommendations typically address multiple domains of functioning. Not all clinical psychologists have explicit training in working with educational settings and learning, however.

Neuropsychological testing is typically more broad, comprehensive, holistic, and integrated, and also appropriate for medical or neurological diagnoses in addition to educational, behavioral, social-emotional, cognitive, and developmental diagnoses. Neuropsychology is all about neurodiversity because neuropsychologists recognize that every brain is different! Neuropsychologists have 2 full years of post-doctoral fellowship training in brain-behavior relationships. Knowledge of neuroanatomy and brain functions guides evaluation and diagnostic determinations. By examining underlying neurocognitive processes in greater detail, it can also provide deeper insight into why individuals may be having certain difficulties.

Sports neuropsychologists are clinical neuropsychologists with additional training related to sports, athletes, and concussions. Although all neuropsychologists receive basic training in the evaluation and management of structural brain injuries (such as a bruise, bleed, stroke, tumor, etc.), not all have the additional specialty training for management of concussions.
These aren't like tests you take in school. Most clients – even teens – are surprised that it wasn't as painful as they may have expected. For many, it's a nice change of pace to sit with someone who listens and to receive positive reinforcement just for trying. Test-takers aren't given a grade, or typically told if their answers are right or wrong. Tests are intended to capture strengths and weaknesses and to help us understand how people approach different kinds of tasks, and to assess relative proficiency in skills related to learning, work performance, and social-emotional and behavioral functioning.
We use whatever tests seem appropriate for the individual to be tested in order to best address the referral concerns. In general, though, evaluations typically include tests tapping verbal and nonverbal reasoning skills (ability), problem-solving, processing speed, memory, language, attention, fine-motor skills/motor planning, and executive functioning. Questionnaires examining personality, interests, and social-emotional/behavioral functioning are usually included as well. The evaluation also includes more than just in-person testing, too. The evaluation itself also includes a review of historical data such as medical and educational records, in addition to clinical interviews to better understand the concerns for which someone is seeking testing.
Formal in-person testing is scheduled for up to 4-6 hours or so (usually over 1 or 2 testing sessions), including breaks to rest, recharge, and have a snack or bagged lunch. Since many tests are untimed, it is often not possible to predict exactly how long testing will take. Additional time is spent after testing to score and interpret testing.
A final 1-2 hour wrap up feedback session is scheduled within 1-2 weeks after testing is completed. At that time the Psychologist discusses the highlights of the evaluation reports and primary recommendations. After that, a few more hours is spent finalizing the final written report of findings and recommendations.

We make every effort to accommodate emergencies and urgent situations, with weekend Concierge services also available. Same-day feedback can be provided if all tests are scored and all data and records are received in advance and all parent(s)/guardian(s) are present, but when possible we prefer to wait a bit and take our time reviewing all of the data again in its entirety, considering all the possibilities and sometimes gathering additional information and specific referrals to facilitate post-testing follow-up and intervention planning.

While this work may be routine for us, it is not at all routine for the client and family. Some time between testing and feedback allows us to thoughtfully consider not just what we think and recommend, but also how best to present that information and which referral resources might be best and accessible.

In a nutshell, YES! Formal in-person testing captures performance at one point at time. Many referral questions and diagnoses focus on patterns of behavior over time, however. ADHD, for example, is a developmental disorder related to attentional control and general self-regulation. Although testing can occur at any age, it is important to look for symptoms dating back to childhood to confirm or rule out a developmental disorder like ADHD. We ask for those records to examine patterns of performance over time and not just the presence of "big problems." So yes, every bit of historical information is important for us to consider, and regardless of whether or not you may think there is or is not something relevant in those records. Even the absence of significant difficulties – and the reasons for it – are important considerations.

A comprehensive, updated list can be found here on the website. In general, however, we ask for just about every scrap of relevant information! This includes, for example, all educational records – report cards, all K-12 standardized testing, conference reports, any other standardized testing like PSAT/SAT, AP, IB, ACT tests (and records of accommodations, if provided), and any post high school transcripts. If school-based supports were provided, we would need copies of all of that, such as 504 Plans and meeting notes, IEP’s, Special Education Evaluation data, college accommodations documentation, etc. If the person to be tested ever received speech/language therapy or participated in psychotherapy (even for unrelated reasons) we would want a treatment summary that includes approximate dates of service,
number of sessions, treatment goals, and progress towards those goals. If there was any formal testing, like from a speech/language pathologist (SLP) or occupational therapist (OT) we would also want formal evaluation data in addition to the treatment summary.

Give us a call. Absence of records doesn’t rule-out testing, although it certainly can help! We can get creative with you and ask for alternate or additional sources of information, such as letters, rating scales, or emails from others such as parents or extended family, other adults present during childhood such as teachers or family friends. Sometimes records may be more accessible than you realize and we can guide you on how to see if that is possible, too.
We charge flat fees for “standard” comprehensive testing, and hourly rates for briefer or screening evaluations. Some individuals start with just a 1-hour consultation or intake interview before deciding to commit to a full evaluation, and that’s O.K. too. Our fees and related policies are detailed in our Clinical Services Agreements, but you can contact our office for our current fee schedule. Regardless of the nature of the services to be provided, all clients are provided with a Good Faith Estimate of anticipated costs as required by federal law when clients will not be submitting claims to their health insurance provider for reimbursement.
Contact us by telephone, email, or our website Contact form and a member of our team will follow-up with you to get a little more information and schedule an initial telehealth intake interview or brief consultation with Dr. Shapiro if you’re not sure if we are the best fit for you. All initial forms are completed electronically, with links provided via our secure Client Portal. If the person to be tested is a minor, the initial intake will be scheduled with all parent(s)/legal guardian(s), only (not the child). Meeting via telehealth makes it easier for all parties to be present, even if participating from different physical locations.

If your child has some awareness of their areas of difficulty, or the reasons for which you’re seeking testing simply say that the psychologist is an expert with that sort of thing and will help them, their parents, and teachers figure out why and what to do about it. You can tell them that the psychologist is a doctor, but not the kind who pokes or gives shots. Rather, they’re a brain doctor and an expert on how kids think, learn, and behave. They’ll ask lots of questions, your child will do some work, and we’ll have advice for them and their parents and/or teachers. We’ll explain more when you’re here.

With young children, sometimes the Psychologist explains by telling them that just like they go to their pediatrician for check-ups, they’re a kind of doctor that does school check-ups to help get them ready for __ grade. We recommend you avoid saying they’ll be playing games – unfortunately, there are no games – or that it’s “testing,” because several hours of testing sounds miserable to most people. The Psychologist usually starts the conversation by asking why they think they’re here and goes from there.

Regardless of how it’s described we try to make it fun, with lots of breaks and positive reinforcement for good efforts. Adolescents are often pleasantly surprised that it wasn’t as bad as they expected. Do let us know if your young child has a favorite animal or popular character that could be helpful to incorporate
with stickers, cards, etc.