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PATIENT FORMS

To make your first visit faster, feel free to download and fill out the following forms and bring them with you. We have also put together some information about items you may want to bring with you and other information about your visit. What To Bring...

 

New Patients

> Demographics

> Health Care Permissions 

> Financial Policy

> Medical History

> Medications

 

Miscellaneous Forms

> Self Referral 

> Patient Survey

> Medical Records Request of Informaton (ROI)

> HIPAA Privacy Policy

> Electromyography (EMG) and Nerve Conduction Studies (NCS)

> Telemedicine Consent Form

> Patient Electronic Communications Consent

> Guardian Email Communications Consent

> Telemedicine Appointment

> Physician Referral Form 

REFERRALS

We require a referral for neurosurgical patients. Referrals don’t need to come from a provider. You can download and complete the Self-Referral Form. To consider any referral we must review all prior imaging including x-rays, CT scans, MRIs, etc., and all applicable treatment records. We need any information about prior treatment or surgery related to the condition you’re asking to be seen for. Gathering this information is the most time-consuming step in the referral process, so your help obtaining all prior documents is vital. We also require all referrals to fill out the Demographics Form. This will help us identify your insurance coverage. We do not accept out of state Worker’s Compensation or Federal Worker’s Compensation.

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