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Patient Forms

Patient Forms

At The NeuroMedical Center we are always working to enhance and streamline your office visits. That’s why we’ve ditched the clipboard of paperwork, and have transitioned for the newest, most secure digital solution. Our pre-registration and pre-visit check-in software, Phreesia, assists us in giving you the best experience possible.  This system helps us to obtain the most up to date information, reduce our paper consumption, and reduce time spent in the waiting room for registration, therefore reducing wait time for seeing your provider. Here’s how it works!

After scheduling your appointment via our call center or online booking tool, you will receive a text message up to 3 days in advance from Phreesia. This message will contain a link asking you to verify your information.

  • New Patients: You will be asked to fill out your demographic information and medical history. After completing this, please review and sign our HIPAA, Privacy, and Patient Policies. If your appointment requires a copay, you can pay that ahead of time!

  • Existing Patients: You will be asked to verify information already in our system, update anything that may have changed, and sign our HIPAA, Privacy, and Patient Policies if it has been over one year since you signed them last. If your appointment requires a copay or you have a balance, you can pay that ahead of time!

Medical Records Requests

If you need to obtain your medical records for personal use, please print out the Medical Records Request form from the appropriate entity.  Complete all fields, then fax or mail to the number/address listed below.  Our Medical Records clerks are available 8:30am-4:30pm Monday-Friday.  Please allow 3 to 7 business days for the complete processing of your request.  In compliance with state regulations, there will be a cost associated with obtaining your medical records for personal use as outlined at the bottom of the form.

The NeuroMedical Center Clinic

(Medical Records Department Located on the 2nd floor)

The NeuroMedical Center Clinic
Attn: Clinic Medical Records Dept.
10101 Park Rowe Ave, Suite 200
Baton Rouge, LA 70810

The Spine Hospital of Louisiana

(Medical Records Department located on the 1st Floor)

The Spine Hospital of Louisiana
Attn: Hospital Medical Records Dept.
10105 Park Rowe Circle, Suite 250
Baton Rouge, LA 70810

The NeuroMedical Center Rehabilitation Hospital

(Medical Records Department located on the 5th floor)

The NeuroMedical Center Rehabilitation Hospital
Attn: Hospital Medical Records Dept.
10101 Park Rowe Ave, Suite 500
Baton Rouge, LA 70810
Fax: (225) 906-3837

Notice of Privacy Practices

The NeuroMedical Center is required by law to maintain the privacy of Protected Health Information (PHI) and to provide you with an explanation of our privacy practices with regard to that information. You have certain rights – and we have certain legal obligations – regarding the privacy of your PHI.  View our Notice of Privacy Practices for a clear explanation of your rights with regard to your PHI.

Medical Appointment Cancellation/No Show Policy

When you schedule an appointment at The NeuroMedical Center Clinic, we set aside enough time to provide you with the highest quality of care. Should you need to cancel or reschedule an appointment, please contact our office as soon as possible, and no later than 24 hours prior to your scheduled appointment. This gives us time to schedule other patients who may be waiting for an appointment.  Please view The NeuroMedical Center Clinic’s Appointment Cancellation / No Show Policy by clicking the link below.

Certification Of Mobility Impairment Form

This is the form that must be signed by a physician and submitted to the Office of Motor Vehicles (OMV)  if you are seeking to obtain a temporary disability/handicap placard and/or license plate.