Patient Information

• Insurance card and a photo ID
• Physician referral form if required by your insurance provider
• A list of medications including the dose and frequency
• Pertinent information about your medical and surgical history
• Any recent EEG's, EMG's, CT scans, MRI's or other test results related to your condition
• Completed patient forms as needed

Please view, print, and complete the following forms as needed for your visits:

• Patient Registration (1 page)
• Health History (2 pages)
• Weekly Headache Calendar (3 pages)
• Parent Behavior Evaluation (1 page)
• Financial Policy (2 pages)
• Hippa Release Form (2 pages)
• Consent to Treat Minor (1 pages)
• Policy Privacy (4 pages)

Our practice is a provider for Medicare and most major insurance plans, and provides insurance billing. Your insurance company may require you to provide a co-payment at the time of your appointment. You are responsible for any charges not covered by your insurance provider. Payment for services not covered by insurance is requested at the time of your appointment. When necessary, our staff will work with patients who request a payment plan.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance provider.

We are happy to process all insurance forms for you as long as you have provided us with the appropriate insurance information. We encourage all patients to confirm their insurance coverage prior to making an appointment with our practice. We expect payment promptly if you receive a bill from our office for balances that may be due. Please feel free to discuss any questions you may have about billing with office staff.