Please print and complete the appropriate Registration form (Adult or Child), as well as the Patient Consent and Release Form listed below.  In addition, please locate any additional Health History Forms required by your doctor, and bring all completed paperwork with you to your appointment.

Patient Registration

Adult Registration Form (PDF Format)

Children's Confidential Personal Data Form (PDF Format)

Patient Consent and Release Form (PDF Format)

Adult Neurology

Ingrid Abols, M.D.

Rajiv Aggarwal, M.D.

Janiece Aldinger, M.D.

Irfan M. Altafullah, M.D.

Elias Bazakos, M.D.

Sarah M. Benish, M.D.

Ivan L. Brodsky, M.D.

Xiaoming Dong, M.D., M.Sc.

Gail Francis, M.D.

Masood R. Ghazali, M.D.

Jessica O. Heiring, M.D.

Charles H. Horowitz, M.D.

Jack E. Hubbard, Ph.D., M.D.

Bruce I. Idelkope, M.D.

Allan P. Ingenito, M.D

Moeen A. Masood, M.D.

Thomas L. Murphy, M.D.

Sotirios A. Parashos, M.D., Ph.D.

Richard A. Peterson, M.D.

Daniel C. Randa, M.D.

Joanne B. Rogin, M.D.

Leland J.C. Scott, M.D., Ph.D.

Steven D. Stein, M.D.

John E. Trusheim, M.D.

Yelena V. Usmanova, M.D., M.Sc.

Alexander Y. Zubkov, M.D., Ph.D.

Felix Zwiebel, M.D.

Pediatric Neurology

Donald J. Chadwick, M.D.

Armantina M. Espinosa, M.D.

Allan P. Ingenito, M.D.

Rehabilitation Services

Rehabilitation

Neurodiagnostic Testing Forms

MRI Medical History Questionairre

Release of Medical Records

Release of Medical Record Procedures

Authorization for Disclosure of Medical Records Form (PDF Format)