Brian D. Loftus, M.D.
6565 West Loop South, Suite 401, Bellaire, TX 77401
713-715-6360 (Directions) 713-715-6367 (fax)
Texas Monthly Super Doctor 2004 & 2005 H Texas Top Doctor 2005
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http://www.bellaireneurology.com/patient_info.html

 

Bellaire Neurology is accepting new patients with or without referral. Please call 713-715-6360 to schedule.

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

Adobe Acrobat
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)

 

Read more about patient charges and insurance.
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©2002 - 2005 Brian D. Loftus, M.D.
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