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Bellaire Neurology is accepting new patients with or without referral.
Please call 713-715-6360 to schedule or submit your request online.
The following forms will help to make your registration process faster
and eliminate some of the paperwork you would normally fill out in the
office before seeing the doctor. Patients are requested to download
these patient forms, fill them out and fax them to 713-715-6367 prior
to your appointment. If you are
not able to print them out, we can fax or mail them to you or you can
come
one
hour
before
your
scheduled appointment and fill them out at the office.
| Form Name and Description |
Microsoft
Word |
|
| Combined form for new patients **(file includes
all forms) |
|
|
| Demographic and insurance form |
|
|
| Patient medical information form |
|
|
| Patient privacy form in English (required by HIPAA) |
|
|
| Patient privacy form in Spanish (required by HIPAA) |
|
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Read more about patient charges
and insurance.
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