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