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?
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 **
Pain Management Agreement **
**When printing forms, please do not print front-to-back. Instead, limit one page per sheet of paper.
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.
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.
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.
If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon ‘Get Acrobat® Reader’. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer