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New Patient Forms
Directions for New Patients:
If you are a new patient to our practice you may fill out your forms either online or you may download/print and complete the forms to bring with you to your appointment. The forms you will need to fill out are: Adults – Patient Hipaa Form, Patient Demographics, and Medical History form. Pediatrics – Patient Hipaa Form, Patient Demographics, Medical History form and any questionnaire’s as instructed at time appointment was made. Please arrive 30 minutes early so we may process your paperwork.

Return Patients:
You will need to fill out and updated Patient Demographic form if you have had ANY changes since your last visit. Please remember you must present your insurance card at every visit and please arrive 15 minutes early so we may process your paperwork.

 

 Patient Hipaa form  
 
 Patient Demographics form  
 
 Patient medical records release form  
 
 Patient Medical History form  
   
 
 Notice of Privacy Practices
 
 Ambulatory EEG Instructions
 

 Regular and Sleep Deprived EEG Instructions

 
 Pediatric EEG Instructions
 
 EMG/NCS Instructions
 
 Epilepsy Monitoring Unit Instructions
   
 
 Insurance List
     
 
Parent/Teacher Rating Scale  
 
Parent Questionnaire  
     
Teacher Questionnaire  
     
Parent/Student Questionnaire