Forms and Instructions

Notice to all patients 

  • New patients please plan to arrive 15 mins early and bring new patient paperwork completed, a list of your medications, copies of records, and any imaging studies/films you may have. 
  • Copays and deductibles are due at the time of service. 
  • All disability and insurance forms filled out by a physician are subject to an appointment and a charge of $25.
  • If an appointment is not cancelled at least 24 hours in advance you will be charged a fee based on your type of visit; this will not be covered by your insurance company.   
  • We do not release your medical information without your authorization.


New patient forms
Download PDF



If you are being seen for sleep, please complete these sleep questionnaires also.
Sleep Questionnaire

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