Please find links below to forms needed to establish a new patient appointment.  Please print each form, fill it out and either fax it back or mail it prior to your appointment.

This office does not bill insurance.  Upon request, we do provide a statement which contains the information required for you to bill.

We accept Visa and Mastercard. 


Blood work requirements

Prior to performing the Neurometric evaluation, it is frequently necessary to obtain certain laboratory studies to rule out any underlying medical conditions.  If you have had any blood work done within the last year, please have a copy mailed or faxed to my office.  If not, we will discuss any necessary blood work when arranging the appointment.

Blood work usually includes a comprehensive metabolic panel, CBC with differential, thyroid function (T-3 uptake, T-4 total) and TSH level.  For females, there may be additional hormonal values requested.

patient information form

study of systems

past and present medical problems

family and personal health history


payment agreement form for neurometric eeg analysis