You can download copies of these forms to use at your convenience. You will need Acrobat Reader to view the file. Acrobat Reader is free and can be obtained from the Adobe site.

New Patient Forms

(see below for New Child Patient Forms)

New Adult Patient Registration

HIPAA Notice (Privacy Policy)

HIPAA Acknowledgement

Adult Medical Records Disclosure and Medical Records Release

Patient Forms

Headache Diary

Sleep Diary

Sleep Study Information

Sleep Study Questionnaire

Comment or Complaint

Narcotic Contract

Child Neurology Forms

New Child Patient Registration

HIPAA Acknowledgement

Child Medical Records Disclosure and Medical Records Release

Guardian Release Form

Child Patient Profile

Child Headache Calendar

Sleep Diary

Map to Our Office

Map to RNA

1. The best healthcare outcomes are based on mutual trust between patient and physician.

2. Patient Expectations:

• To set my own priorities.
• To say no without feeling guilty.
• To ask for what I want.
• To get one's money’s worth
• To ask for information.
• To make mistakes.
• To choose not to assert myself.
• To change one’s mind.

3. Patient Responsibilities:

• To keep scheduled appointments.
• To be honest with the doctors & other health-care workers.
• To give information about experience & condition as clearly & briefly as possible.
• To understand that no one has all the answers to MS
• To follow the treatment plan agreed upon.
• Bring a list of the names and addresses of your other health care providers.
• Please bring to your appointments the medications (actual bottles) that you are currently taking.
• Know what medications have been used unsuccessfully on you in the past.
• Please let us know if you are taking alternative medications such as St. John’s Wort, Echinacea, Valerian Root, etc. Your doctor needs to know this!
• Know what allergies you have.
• Understand the requirements of your own health insurance. (It is virtually impossible for us to keep all of the health plans straight, but we sure try!)
• How does your pharmacy plan work? Is your prescription plan mail-away or local purchase? Do you want 3 month or 1 month prescriptions?

4. Being an advocate means…

• Educating yourself.
• Getting good advice.
• Finding allies.
• Figuring out how to make the system work for you.

5. Prepare for your office visit by:

• Organizing your thoughts to make the most of your limited time.
• Make lists or write down what you don’t want to forget.
• Keep a diary.
• Bring a friend or family member along particularly if you get tongue-tied in a doctor’s office.

6. During your office visit:

• Ask, what is my diagnosis?
• Do I understand it well enough to explain it to a family member? If not, have the physician explain it to you again.
• Ask, what can be done to improve my situation?
• Ask, are there any lab or diagnostic tests for me?
• Ask, why am I doing that?
• How do I arrange and prepare for the tests?
• Will the physician call me with the results or should I call the office?
• What medications are being prescribed for me?
• What are the expected side effects? Note: Just because a physician mentions side effects does not mean you are going to experience these side effects
• Don’t waste time. Time wasted playing with prescriptions, hassling with managed care issues, and struggling with certification logistics is time you are not spending with your health care provider on important issues.

Major Tip

• By learning everything you can about your health benefits, your visits will be more efficient.
• Your time is just as valuable as your health care provider’s time. Following these simple guidelines and being prepared for your visits will not only make them more enjoyable, but also will undoubtedly increase your level of care.