PATIENT FORMS

Before your first appointment, please download, print and complete these forms.

     

    WHAT TO BRING TO YOUR APPOINTMENT

    • Your insurance card
    • Your driver's license or photo identification
    • Physician referral forms, if required by insurance
    • A list of current prescriptions and/or over-the-counter medications you are taking, including dose and frequency
    • Pertinent information about your medical and surgical history
    • Any recent labs, X-rays, MRIs, CTs, or appropriate records you may have

     

    Records

    All dictated notes, labs, and out-patient testing ordered or performed by our physicians, and/or any other pertinent information regarding your treatment, is sent to your referring physician(s).

    If for any reason you would like a copy of your records, there is a processing charge for copying of records:

    • $25.00 for the first 20 pages and $.50 for every additional page.
    • MRI images on CD cost $10.00 per disc.
    • Films cost $3.00 per sheet.

     

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    Insurance and Payment Information

    Neurology Consultants of Dallas is a provider for Medicare and most major insurance plans. We provide insurance billing. Anything not covered by insurance will be your responsibility.

    We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. 

    If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at 214.750.9977. Questions regarding your coverage and benefits should be directed to your employer or insurance company.

    We now accept Care Credit which offers special financing for healthcare needs. Click below to find out more or apply.

     

     

     

    Notice of Privacy Practices

    State and Federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this Notice of Privacy Practices. Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients. A copy is available upon request.

     

    Preparing for Your Diagnostic Test

    If you would like additional information about your upcoming diagnostic test, you may follow these links.