10101 Park Rowe Avenue Baton Rouge, Louisiana 70810

Clinic: (225) 769-2200  / 

Spine Hospital: (225) 763-9900  / 

Rehab: (225) 906-3838

Three Entities, One Family. Choose Your Destination:

The NeuroMedical Center’s Patient Forms

All forms and documents available for download are in PDF file format. Please complete the necessary paperwork prior to your visit.

The NeuroMedical Center Clinic

Clinic Patient Registration Form

All new Clinic patients must complete this form prior to their first appointment or if it has been more than three years since their last appointment. This form can also be used to update change of address.

New Clinic Patient Medical History Form

Authorization to obtain new Clinic patient’s Medication History

New Clinic Patient Intake Form

All new Clinic patients must fill out an assessment that addresses health history, current medications and systems to help determine appropriate care, treatment and services. Also necessary for patients who have not had a Clinic appointment for 3 or more years.

Notice of Privacy Practices

A clear explanation of individuals’ rights with respect to their personal health information.

Medical Record Release Form

Necessary for individuals seeking to obtain copies of Clinic medical records. Can be faxed or mailed.

Certification of Mobility Impairment Form

Required by the Office of Motor Vehicles for patients seeking to obtain a handicapped hang-tag and/or license plate. A physician must fill this form out for the patient to take to the Office of Motor Vehicles.

Physician Referral Form

Allows doctors and their staff to begin the process of referring a patient to The NeuroMedical Center Clinic.

The Spine Hospital of Louisiana

The Spine Hospital of Louisiana Medical Release Form

Necessary for patients seeking to obtain copies of their Spine Hospital of Louisiana medical records.

The Spine Hospital of Louisiana Sleep Study Referral Form

allows doctors and their staff to begin the process of referring a patient to The Spine Hospital of Louisiana Sleep Center.

Notice of Privacy Practices

A clear explanation of individuals’ rights with respect to their personal health information.

The Rehabilitation Hospital

Latest News

The Spine Hospital of Louisiana Earns Patient Safety Award and $2,000 Grant

April 26, 2017
The Spine Hospital of Louisiana at The NeuroMedical Center is proud to announce it is the recipient of a LAMMICO Patient Safety Award and Grant. The Spine Hospital was awarded $2000 grant from the...

Clinical, Forensic, and Medical Psychologist Joins The NeuroMedical Center Team

April 25, 2017
The NeuroMedical Center (NMC), home to the South’s largest team of experts for the brain, spine, and nervous system, is pleased to announce the introduction of clinical psychologist, Darla M. R....

Minimally-Invasive Radiofrequency Ablation (RFA) at The Spine Hospital of Louisiana to...

March 30, 2017
  Unlike pinched nerves which cause radiating pain, localized low back pain is typically caused by either the facet joints or medial branches.  Facet joints endure a lot throughout your...