Get New Patient Referral Form - Tallahassee Neurological Clinic

Filling out the New Patient Referral Form for the Tallahassee Neurological Clinic is an essential step in referring patients for appropriate care. This guide provides a clear and detailed walkthrough of the form's components to assist you in completing it accurately and efficiently.

Follow the steps to complete the form easily.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the appropriate department for referral by checking the corresponding box, such as 'Neurology,' 'Neurosurgery,' or 'Pain Management.' Be sure to note any preferred physician, if applicable.
3. Indicate the type of appointment requested by checking the relevant option, such as 'New Patient Consultation' or 'EMG Study.'
4. Answer the questions regarding any prior injuries or accidents, such as whether the visit is related to an auto accident or a worker’s compensation injury by selecting either 'Yes' or 'No.'
5. Provide patient information, including name, date of birth, address, email, phone number, and insurance details. Ensure the information is accurate to facilitate the referral process.
6. Fill out the referring physician’s information, including name, phone number, and fax number. This information is required for communication regarding the referral.
7. Specify the diagnosis or reason for the visit in the designated field, which will help the clinic understand the referral's purpose.
8. Obtain the signature of the referring physician, which is necessary to finalize the appointment request.
9. Once you have completed all sections, you can save changes, download the form, print, or share it as necessary.

Take the next step in patient care by completing the New Patient Referral Form online today.