New Patient Forms

(see below for New Child Patient Forms)

New Adult Patient Registration
(PDF / Online)

HIPAA Notice (Privacy Policy)
(PDF / Online)

Acknowlegement of Receipt of Notice of Privacy Practices
(PDF / Online)

Authorization to Release Health Information
(HIPAA Release)
(PDF / Online)

Medical Records Release
(PDF / Online)


Patient Forms

Headache Diary
(PDF)

Sleep Diary
(PDF)

Sleep Study Information
(PDF)

Sleep Study Questionnaire
(PDF / Online)

Comment or Complaint
(PDF / Online)

Narcotic Contract
(PDF / Online)


Child Neurology Forms

New Child Patient Registration
(PDF)

New Child Patient Registration (Patients of Dr. Milowic only)
(PDF)

Child Patient Profile
(PDF)

HIPAA Acknowledgement
(PDF)

Child Medical Records Disclosure and Medical Records Release
(PDF / Online)

Guardian Release Form
(PDF / Online)

Child Headache Calendar
(PDF)

Sleep Diary
(PDF)


Neuro-ophthalmology
Forms

Patient History Form
(PDF / Online)

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.

Map to Our Office

Map to RNA

 

   
Dr. John D. Wooten
A Garner native, Dr. Wooten graduated from Duke University in 1980 More
Dr. Kevin M. Rathke
A clinical researcher focused on epilepsy and headache … More
Dr. Traci I. Sheaffer
Dr. Sheaffer was born in Asheville, NC and graduated … More
Dr. Kristi L. Milowic
Dr. Milowic was born in Hawaii and as a child of a military family… More
Dr. Matthias Zinn
Dr. Zinn was born in Marburg, Germany. He received… More
Leslie Boyce, M.D.
Dr. Boyce was born and raised in New Jersey ... More
Wanda Cecil
Certified pediatric nurse practitioner Wanda Cecil completed her … More
Child Neurology Services & Procedures

Evaluation and treatment of child neurological and developmental disorders

This area is under construction.