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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 Patient Consult 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

Raymond Rybicki, MD

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

The materials provided at this site are for informational purposes and are not intended for use as diagnosis or treatment of a health problem or as substitute for consulting a licensed medical professional. Check with a physician if you suspect you are ill, or believe you may have one of the problems discussed on our website, as many problems and diseases may be serious and even life-threatening. Also note while we frequently update our website's content, medical information changes rapidly.

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