New Patient Forms

You can access the new patient packet of forms and the medication log using the links below. Once open, please print the entire packet and then complete the forms before your appointment. Please bring the completed forms to your first appointment. It may take a few minutes to download depending on your connection speed.

New Patient Packet (PDF)
Medication Log (PDF)
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Enclosed in the new patient packet is a patient registration form, medical information form, a consent form, our privacy notice and other policies. Completion of these forms is vital for the efficiency and thorough evaluation of your condition and health needs.

Your First Appointment

Please arrive at least THIRTY MINUTES AHEAD of time so that we may compile any additional information before your scheduled appointment even if you are bringing completed patient forms. Using the link above, you can print the new patient forms to complete them in advance. If you are late for your appointment, rescheduling may be necessary.

Please bring the following:

• Patient's insurance card
• Physician referral forms if required by insurance
• Any recent x-rays or appropriate records you may have
• Your completed patient forms, or the following information in order to complete them at the office:
  • A list of current prescription or over-the-counter medications, including dose and frequency
  • Pertinent information about the patient's medical and surgical history

Payment and Insurance

North Texas Neuroscience Center is a neurology specialty office. Most HMO plans require a referral from your primary care physician for a visit to a specialist. A referral must be in place prior to your visit, or you will be personally financially responsible for any and all charges incurred from your visit. Please bring a referral form your primary insurer.

Your co-payments or payments toward your insurance deductible will be collected at the time of your visit, this includes Medicare patients. We will file secondary insurance, however if you have Medicare please ask them to file for you. If you have no health insurance, payment is expected at the time of your appointment, in the form of cash, checks, major credit cards or money orders.

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

Our Financial/Office Policy (PDF)
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Prescription Refills

We will provide refills for medication that we have prescribed as long as certain guidelines are followed. Please do not wait until you have exhausted your supply of medication before requesting refills. If your request is appropriate and is received prior to 3:00 p.m. on a regular business day, we will attempt to refill the same day. After hours, on weekends, and on holidays, the on-call physician CANNOT refill prescriptions or begin new medications.

Hospital Affiliations

All of our physicians are affiliated with the following hospitals.

• Baylor Specialty Health Centers - Hospital
• Baylor Regional Medical Center at Grapevine - Hospital
• Baylor Medical Center at Irving - Hospital
• Las Calinas Medical Center - Hospital
• Irving Coppell Surgical Hospital

Privacy Policy

Our Notice of Privacy Practices is part of the new patient forms packet above but it is also found at the link below for your ease of reference:

Our Notice of Privacy Practices (PDF)
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