New Patient Registration Forms: These forms are for new patients to complete. These forms can be updated as needed from time to time. However, it is important to have these forms completed and returned to the office before your first appointment with us.
Medical Record Request Form: This form is used when you are requesting a copy of our practice medical record pertaining to your care. A third party is used for these services and charges may apply.
Release of Medical Information Authorization Form:
This form is required to allow our practice to retrieve medically relevant information from other providers, hospitals or radiological centers. This form is already included on the New Patient Registration Form and may be updated from time to time.
All completed forms could be returned by either mail, in person, by fax (352-732-0239) or by email (Brain@GayaNeurology.com).