Forms and Instructions

New patient forms
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Privacy Note (For your information only)

Record release forms
Record Release Form (to Southlake Neurology)
Record Release Form (from Southlake Neurology)

 

Notice to all patients

  • New patients please bring you list of medications, copies of records, and any imaging studies/films you may have.
  • Copays and deductibles are due at the time of service
  • Cancellation fees of $25 may apply if the office is not notified of cancellation within 12 hours of appointment
  • All disability and insurance forms filled out by physician are subject to a charge of $25