North Georgia Neurological Clinic: Important Paperwork

Important Paperwork

Please read Notice of Privacy Practices (HIPAA) before signing related authorization forms.

New or established patients, please bring to your appointment the following:

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Your insurance card and photo ID

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A list of current prescription and over-the-counter medications you are taking, including dose and frequency

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Pertinent information about your medical and surgical history

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Any recent MRI or CT scan, and/or appropriate medical records you may have

In addition, new patients should bring completed and signed New Patient Packet forms (six forms, plus an optional credit card form).

The New Patient Packet is provided in Acrobat PDF. Please click here to download the packet to your computer, print it, and then complete and sign the forms. The packet includes the following forms that can be downloaded individually:

–	Financial Policy
–	Medical questionnaire
–	Patient and Insurance information If you are a new patient, or an established patient and your insurance has changed, please complete this form.
–	Authorization for treatment and assignment of benefits
–	HIPAA authorization Form Click here to read Notice of Privacy Practice before signing these forms.
–	Permission to use Credit Card (Optional)

The Authorization to Release/Obtain Information is provided in Acrobat PDF. Please click here to download the form to your computer, print it and then complete and sign the form to give NGNC permission to send /request your medical records or other information to/from entities not associated with NGNC. Once the form is completed, you may mail, fax or bring the form to the office.

You can download Adobe Acrobat Reader from http://get.adobe.com/reader/.