New Patient


 

Welcome to the Center for Neurology and Neurophysiology, P.A. In the patient packet, you will find forms to document your patient history and previous medical information, a consent form to release medical information, and a privacy notice. To ensure you are seen in a timely manner, these forms should be completed prior to your appointment. Please pay special attention to your current medications and include dosage and frequency in the medication section. Once you have completed filling out the packet on your computer, please print, sign, and bring it with you to your appointment. If you are a first time patient, please show up twenty minutes early to your appointment.


Patient Packet

Click here to download our Patient Packet.

(paquete de nuevo paciente en espaƱol)

Headache Questionnaire ** Please complete if you are being seen for migraines, chronic migraines or headaches. **


Additional Forms

Medical Release Form - Records needed for continuing care purposes will be sent directly to the physician we refer you to upon their request. For all other providers our office will need you to sign a Medical Release Form. Requests for medical records for reasons other than continuing care require a $25 Medical Request Fee be paid in advance of your request.

EMG Referral Form - A number of disorders are better identified and more effectively diagnosed using Electromyography and Nerve Conduction Studies in conjunction with Magnetic Resonance Imaging (MRI). Please consider referring your patients for EMG/NCS testing to help you deliver an accurate diagnosis in confidence. Our Board Certified Neurologist is fellowship trained in neurophysiology.


Participating Insurance

We are continuously adding new insurance carriers to our list. If your insurance provider is not listed here please call us at (214) 494-4424 to speak with one of our staff members about your particular insurance type.


IN-NETWORK
  • Aetna HMO/PPO
  • Aetna Medicare - HMO with a referral
  • Baylor Scott and White Employee Plan - CIGNA
  • Baylor Scott and White HMO/PPO
  • Beech Street PPO
  • Blue Cross Blueshield PPO/POS/HMO/HMO Exchange Plan
  • Blue Advantage; Blue Choice PPO; BlueOptions; Blue Essentials (fomerly HMO Blue Texas); Blue Essentials
  • Access
  • Bravo Health Medicare Care Improvement Plus
  • ChoiceCare (Humana) Concentric Network
  • ChoiceCare (Humana) Medicare
  • Medicare Advantage
  • ChoiceCare (Humana) HMO/PPO
  • Choicecare Medicare Advantage PFFS
  • Cigna HMO/PPO
  • Cigna Local Plus (Dr Ulrich)
  • FEDMED PPO
  • FirstHealth/Coventry Network PPO
  • FirstHealth/Coventry Medicare Advantage
  • Galaxy Health Network PPO
  • Galaxy Health Network Medical Savings Card
  • HealthSmart PPO-POS / Accel-GEPO
  • Independent Medical Systems
  • Optum Health
  • Medicare as a Non-Participating Provider
  • Medicare Railroad
  • PacifiCare
  • PlanVista Solutions PPO
  • Texas True Choice PPO
  • United Healthcare and Affiliates HMO/PPO
  • United Healthcare Charter
  • United Healthcare and Affiliates Medicare
  • Molina Exchange Plan

OUT-OF-NETWORK
  • Ambetter
  • Aetna QHP
  • Baylor Scott and White Aetna
  • Baylor Scott and White BCBS
  • Baylor Scott and White Baylor Quality Alliance (BQA)
  • Oscar
  • Texas Health Aetna
Our Locations

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