(512) 392-0710 DrDees@Neuroclinictx.com

Forms

Patient Forms

     The following forms can be downloaded or printed, and should be completed prior to your appointment at The Clinic.

     These forms are quite comprehensive and will likely take 1-2 hours to complete. It is important that Dr. Dees has this information prior to your first appointment so that he can review and discuss each item with you prior to beginning testing. Please do your best to fully complete each form. If you need a family member to assist you, that would be acceptable.

     If you would prefer that we mail you these forms, please let us know.

FINANCIAL RESPONSIBILITY

PATIENT INTAKE

INFORMED CONSENT

HIPPA ACKNOWLEDGEMENT & CONSENT

NOTICE OF PRIVACY PRACTICES

YOUR PATIENT RIGHTS