New Patient Forms

 
Thank you for choosing Las Vegas Neuroscience Institute for your neurological care. We welcome you.

We are here to make sure your office visit is as quick and hassle-free as possible. If you are a new patient, please complete our Patient Information Forms (available in PDF format) before your scheduled appointment

 

Your First Appointment

If you are a new patient to our practice, please arrive 30 minutes prior to your scheduled appointment. Upon your arrival, please check in at the front desk. At your first visit, you will be asked to do the following:

A. Complete a patient registration form. *
B. Complete a medical history form. *
C. Present your insurance card and Driver License.
D. Acknowledge receipt of our Notice of Privacy Practices.
E. Sign an authorization to release confidential health information. **

* You can save time by downloading new patient forms from our website and filling them out in advance

If you are a returning patient, please arrive 15 minutes prior to your scheduled appointment. At your return visit, our staff will confirm your name, address, telephone numbers and your insurance information to ensure our records contain the most current information.

What to bring to your appointment?

Insurance card
MRI or CT (The actual films AND the paper report. CDs will not be accepted)
List of your current medications.
Referring doctor’s address, phone, fax number.
Referral, if required by your insurance.

New Patient Forms **

New Patient Packet (English Version ) (PDF)**
New Patient Packet ( Spanish Version ) (PDF)**

Pain Management Agreement **

Pain Management Agreement (English Version ) (PDF)**
Pain Management Agreement ( Spanish Version ) (PDF)**

**When printing forms, please do not print front-to-back. Instead, limit one page per sheet of paper.

Insurance

We accept most major insurance plans, Medicare, and Federal worker’s compensation. You will be required to have your insurance card and co-pay available at the time of your visit. We will assist you with the billing of your primary insurance. Letters of protection are not accepted.

Authorizations

It is your responsibility to ensure whether a service is covered on your insurance plan. You may need to contact your insurance company before making the appointment to determine this.

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, and a copy is available upon request.

 

 

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