New Patient Form

Welcome to our office. We’re so glad to have you as our patient! Kindly fill out this form if you are new.New Patient Form

New Patient Questionnaire

We’ll need to know a little bit about your medical information. What you tell us will help us to give you the very best of care!New Patient Medical Questionnaire

Medical Reconciliation

This form is completely voluntary. If you would like us to be able to release health information identifying you, we need to have your consent.Medical Reconciliation Authorization

Resolution of Concerns

This is the agreement about how we will decide to resolve any concerns that should arise.Resolution of Concerns

Privacy Practices

We will do all that we can to inform you of your rights related to your personal health information.

Privacy Practices

Notice of Privacy Practices

This form will describe how your medical information may be used or released and how you can get access to it.Notice of Privacy Practices

NeuroLens Lifestyle Index

This questionnaire is meant to help your doctor understand what you’re experiencing on a regular basis.

NeuroLens Lifestyle Index

Please Note: some forms may download to your computer’s “Downloads” area.