For New Patients


READ THE FOLLOWING (items in RED):

New patients or returning patients who have not gone through the new patient process should read the following items.

▶ New Patient Letter ▶ Notice Of Privacy Practices (HIPAA) ▶ Pediatric Only - Letter from Dr. Peter Heilbroner

PRINT AND FILL OUT THE FOLLOWING (items in GREEN):

In order to make your first visit to our office as convenient for you as possible, we encourage you to print, read, and fill out the registration form, appropriate history form(s), both sections of the HIPAA acknowledgement form, and the Financial Services Guidelines before you arrive.

Bring the completed forms when you come for your office appointment.

▶ Patient Registration Form ▶ Adult Patient History Form ▶ Pediatric Patient History Form ▶ HIPAA Privacy Acknowledgement   - and -
    Authorization For Use And Disclosure Of Protected Health Information Form
▶ Financial Service Guidelines

If you are being treated for headaches, please complete the Headache History Form in addition to the Adult Patient History form.

▶ Patient Headache History Form

ADDITIONAL INFORMATION:

Valet parking is available daily from 8:00 A.M. until 4:30 P.M.

The service is free and tipping is not obligatory.


About HIPAA:

The federal Health Insurance Portability and Accountability Act (HIPAA) exists to protect your rights to the privacy of your health care information. In order for Neurology Group to maintain your medical record and coordinate your care, we need your permission.

The "HIPAA Privacy Practices Acknowledgement" form indicates that you have read and understand the "Notice Of Privacy Practices". The "HIPAA Authorization For Use And Disclosure Of Protected Health Information" form allows our physicians and staff to discuss the contents of your medical record with those you designate and your primary contact information.




Disclaimer: This website is for informational purposes only and is not intended to be a substitute for diagnosis or treatment. If you think you may have a medical emergency or have an urgent matter, call 911 or your doctor immediately. E-mail addresses provided on this website are to be used by our patients for business purpose only. Any sent or received e-mail messages are not to be considered private or confidential. We reserve the right to review any and all e-mail messages sent to us.