If you are new to our practice or have not been seen in over 1 year, below are links to common forms we need our patients to complete prior to their visits/procedures. Some forms are required prior to each visit.

New Patient Forms

To be completed prior to your appointment(s).

• New Patient Packet – General Neurology
• New Patient Packet – Multiple Sclerosis – Possible or Diagnosed
• New Patient Packet – Pediatric Neurology

Authorization to Release Medical Information Form

To be completed prior to the release of medical information.

• Authorization to Release Medical Information

Benefits Data Consent Form

To be completed once per year.

• Formulary Benefits Data Consent Form_2015v.3

HIPAA Communication Form

To be completed once per year.

• HIPAA Disclosure Form – Patient_2015v.3

Notice of Privacy Practices Acknowledgement Form

To be completed once per year.

• Notice of Privacy Practices Acknowledgement_2015v.3

Summary of Privacy Practices

For reference.

• Summary of Privacy Practices_2015v.3
• Notice of Privacy Practices – Long Version_2015v.3