Neurosurgical Consultation Checklist

If you are scheduled for “Neurosurgical Consultation”, please bring the following items with you to your appointment (do not mail any of these items).

• Completed Patient Information Form

• Completed Medical History Questionnaire

• Medical Insurance Card

• Current X-rays and/or MRI’s pertaining to your appointment (Do not have the hospital mail these to us – these are very important to evaluate your needs. Failure to bring in your x-rays and/or MRI’s may result in rescheduling your appointment, thus delaying your care.

• Workers Compensation Injury (if applicable) – please complete page two of the Patient Information Form.

• If you are unable to keep your appointment, please call us at least 24 hours in advance to reschedule.

Direct all insurance and billing questions to 1.207.885.4417.