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Patient Forms

Preparing for Your Visit at The Neuron Clinic

If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.  This will make your visit more efficient and will make better use of your time in our office. Please always bring a current ID and insurance card to your appointment.

New Patient History

New Patient Information

Notice of Privacy Practices

Telemedicine Consent

Patient Termination Policy

Cancellation/No Show Policy

Authorization to Release Medical Records

PHQ-9 and GAD-7 questionnaire 

Assignment of Benefits Form

Patient Financial Responsibility Consent

Customer Comment Form

  • Office Hours

    • Monday to Friday
      8AM to 6PM
    • Saturday
      Closed
    • Sunday
      Closed

    • The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.© 2023 The Neuron Clinic. All rights reserved.