• Financial Policies
  
• Insurance Authorization Form
  
• Consent for Using Patient Portal
  
• Consent for Access to Medication Information
  
• Controlled Substance Agreement
  
• Policies on Medication Refills and Authorization
• Policies on Delivery of Test Results

In order to ensure that your visit is as swift as possible, please feel free to print and complete any of the following forms applicable to your visit. Arriving with all necessary paperwork greatly assists our staff in creating and updating your file while limiting your overall wait time.  If you have any questions about any of our forms, please contact our staff for more information.​

Patient Resources

• ​​​​HIPPA Privacy Authorization Form *
  
• Power of Attorney Form
  
• Authorization for Release of Information
  
• Test Results Request Form
  
• Controlled Substance Agreement 
  

​​​​​​Medical History Questionnaires​ (* essential)

All patient information is stored electronically.  New patients may register online, and established patients may use a home computer or smartphone to access to their medical records.  

Electronic Patient Chart Access 

• Online New Patient Registration
  
• Patient Portal and Smart Phone App (Free)
  

The following consent and agreement forms can be signed into effect electronically with a Kiosk at the time of check-in:

• National Institute of Neurological Disorders and Stroke
  
• Division of Neuroscience at National Institute ​on Aging (NIA)
  
• Neuroscience@NIH​
  

New Patient Forms (* essential)

• New Patient Registration Form
  
• Financial Policy *
  
• Insurance Authorization Form *
  
• Consent for Using Patient Portal
  
• Consent for Access to Medication Information​ *
  

• ​Medical and Neurological History Questionnaire *
  
• Review of System Questionnaire
  

Contact

​ANYTIME-n-ANYWHERE PARKINSONS CARE

• About Anytime and Anywhere Care
  
• CCM Consent Agreement
• Chronic Care Management Services from Medicare
  

• National Institute of Mental Health​
  
• American Academy of Neurology
  
• American Association of Neurological Surgeons
  
• International Parkinson and Movement Disorder Society
  

• List of Current Medications and Pharmacy Information Form *
  

Patient Information on Neurological Disorders:​

• ​Telemedicine Consent Agreement
  
• Credit Card Authorization Form
  
• Consent for Using Apple FaceTime and iMessage