Consultants in Neurology, S.C. limits its practice to the field of neurology. Because of this specialty, almost all of our patients are referrals from other physicians.
Our patients fall into two categories. Many of our patients are referred only for the purpose of neurological testing. Our test results are sent back to the referring physician. These patients need to complete our "short form" Test Referral Forms.
Other patients stay with this office for continued care and treatment for certain neurological diseases such as Multiple Sclerosis and other spine, nerve and muscle disorders. These patients need to complete our"long form"New PatientConsult Forms.
Both of these form packages can be downloaded from this page. The PDF Adobe icon provides our forms in a manner such that the fields can be filled out on your computer. The Microsoft Word icon allows you to download and print the forms so that they can be filled out in pen or pencil. These forms can be picked up at our office or will be mailed to you. If you have any questions, please call our office at (262) 631-8550.
The "short form" Test Referral package contains:
Short Form Medical History Assignment of Insurance Financial Policy Information on EMG/NCS
The "long form" New Patient Consult package contains:
Long Form Medical History Assignment of Insurance Financial Policy New Patient Appointment
Before a doctor or clinic will send or receive a patient's medical records, the patient must sign and date a statement authorizing the transmittal of his or her confidential medical records. The following are forms that you can download in either PDF format or Microsoft Word format for this purpose.
Medical Record Release To: Another physician or clinic From: Consultants in Neurology, S.C.
Medical Record Release
To: Consultants in Neurology, S.C. From: Another physician or clinic
Below are miscellaneous forms sometimes used in our practice. If requested by one of our physicians, these forms can be filled at your convenience and brought to your appointment.
Please click on the PDF icon or the Microsoft Word icon of the form that you wish to view or download. The Adobe PDF form is intended to be filled out on your computer and then printed to your printer. The Microsoft Word form is designed to be downloaded and printed on your printer and then filled out in pen or pencil.
'll find additional forms that can be downloaded to
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