Patient Forms

General CNS Forms

  • NEW PATIENT PACKET for all offices, including:
    • PATIENT’S DEMOGRAPHICS form
    • IMPORTANT PATIENT INFORMATION form
    • FINANCIAL AGREEMENT form
    • HIPAA ACKNOWLEDGEMENT & DISCLOSURE form
    • INSURANCE AUTHORIZATION & ASSIGNMENT form
    • PATIENT RELEASE OF MEDICAL RECORDS form
    • CURRENT INFORMATION form

Seizure and Epilepsy Clinic Forms

FAQs

  • How do I make an appointment?

    We take pride in our scheduling system being smooth and efficient. If you have trouble getting an appointment after leaving a message for more than 24 hours, please send an appointment request at https://thecns.com/appointment/, or leave a message at a special scheduling number: 833-4444-CNS (267) and select option #1. Our intake specialists are trained to get all the information necessary from you, including insurance information and referral, if needed.

  • Will I have to wait for a long time to get an appointment?

    Our wait times vary by provider, however, we have nurse practitioners as well as new neurologists who can accommodate a priority appointment. We try our best to accommodate patients with urgent neurological needs within 48 hours. Our front office staff will be able to give you a reasonable estimated wait time at the time of your inquiry.

  • How do I know if I should get a second opinion?

    We work with national experts and we also coordinate second opinion consultation, if necessary.

  • What to expect on my appointment? (NEW PATIENTS ONLY)

    New patients are scheduled for a thorough examination. You will first spend a few minutes at the registration desk to go over demographic and insurance information. You will be asked to provide a state-issued identification card (e.g., Driver’s license), insurance card, referral, co-payment, and list of current medications. If you do not have a state-issued identification card with your photo, we will snap a quick photo for our physician’s reference. If you have already accessed our website and printed our New Patient Forms, we will collect them at this time. Otherwise, you can fill them out at check-in. You will then be taken into the exam room, where you will have a brief interview with our clinical staff to compile your chart, and you may also have your vitals taken at this time. Our Provider will then spend most of the appointment with you engaging in conversation, regarding your medical history and chief complaints to familiarize him/herself with your conditions. The provider will also perform the physical and neurological examination at this time. After discussing your treatment plan in detail, your appointment will end back at the registration desk, where you will make your follow-up appointment and receive any written prescriptions, orders, patient education, and/or, prescriptions samples and coupons.

    Follow-up appointments are scheduled for 15-30 minutes. Please remember to bring a current, updated list of medications to each follow-up visit. It is important to bring medical investigations including, lab work, CT scans, MRI reports, and CD of the pictures with you in an each-and-every follow-up visit. After a brief registration at the front desk and chart update with our clinical staff, you will meet with our physician to review the results from any diagnostic imaging or procedures, lab work, and/or physician consults done during the interim. Medication and treatment adjustments may be made at this time.

    We have an Electronic Medical Records (EMR) system, which includes, your encounters, physician’s assessments, and the plans regarding your condition. are typed as the encounter proceeds so that the consultation notes are ready to be faxed to your primary care and referring physicians on the same day.

    Our physicians understand the importance of communicating with your primary care physician and other consultants. Depending on providers’ preferences, the notes are taken during or after the encounter. The Medical Scribe may be used by some providers.

  • What makes us different from others?

    Our board-certified physicians understand the seriousness of a neurological diagnosis. We offer our patients cutting-edge knowledge and care, and yet remain compassionate and supportive. We work in harmony with surrounding tertiary care centers to provide you with all the expert opinions that you need. Our experienced medical assistants are highly trained and specialize in neurological care and other advanced treatment methods. Our office is entirely computerized, utilizing Electronic Health Records. This ensures easier communication with primary care providers. We also offer extended late hours. Our physicians use email, as well as phones, to communicate with patients.

  • How do I deal with insurance claims for Office Visits?

    Our billing department will file an insurance claim on your behalf, but we ask that you bring your insurance card with you on each visit. Please notify us of any change in your insurance.

  • Do I Need to file an insurance claim?

    We accept the majority of insurances. Our billing department will file your insurance claim on your behalf to ensure the most uncomplicated and non-stressful experience.

  • What if I do not have insurance coverage?

    Our experienced office staff will help you obtain emergency medical assistance coverage where applicable through state agencies, and provide you with a list of insurance companies that may be willing to provide coverage. We will also apply for assistance on your behalf with different pharmaceutical company’s foundations.

  • Who do I contact in case of emergency?

    If you have a medical emergency, please dial 911 or go to the nearest emergency room.

  • Can I pay my Bill Online?

    Yes, you can. Click Pay Your Bill button on the main menu, it will take you to the secure Patient Portal link.

  • What is Patient Portal?

    A Patient Portal is secure area of our website, where a patient creates an account to communicate with us. After logging in to your account, you can see your medical records, ask questions to your provider, or Pay Your Bill Online. You can access the Patient Portal by clicking here.

  • How do I leave feedback for CNS?

    Please visit the feedback tab, Or click here.

Sliding Fee

Doctors Care uses a sliding fee scale to set your visit cost. The cost is based on your family size and income. We accept all patients, even if they cannot pay the full cost. Use the calculator or chart below to find your sliding fee rate. If you have any questions or are worried about paying for care, call us at 833-4444-CNS.

Sliding Fee Scale Policy

Sliding Fee Scale (SFS) policies provide the specific instructions or procedures for implementing the SFS. The SFS policies ensure that the SFS program is patient-centered, improves access to care, and assures that no patient will be denied health care services due to an inability to pay. At a minimum, within the policy, the following areas must be addressed:

  1. The purpose of the SFS, which is a model for payments administered to patients which are fees for services that are adjusted depending on an individual’s income that is set to allow for fairness and to address income inequality;
  2. Patient eligibility for the SFS program which is determined based off of income and family size;
  3. Documentation and verification requirements to determine patient eligibility;
  4. An explanation of SFS charges based on Federal Poverty Level;
  5. Process of assessing patient’s continued eligibility for the SFS program;
  6. How the SFS program will be advertised to the patient population, which the SFS will be
    advertised on the practice’s website and in our offices; and
  7. Exclusions to the SFS program which includes exclusion of testing procedures such as Botox plus all injectables, EMG, EEG testing (Routine or AMB), CD/TCD, Sleep Studies, TMS, and infusions for patient’s who do qualify for the SFS program;

Insurances Accepted

It is unfortunate that HMOs and other managed care companies have implemented policies that inconvenience both the patient and the physician; however, we must follow the rules. If an authorized referral is necessary for services, it is the patient’s responsibility to make sure the office is supplied with the referral prior to the visit. Our policy is that if a referral has not been received by the time of visit, you may choose to reschedule the appointment until the referral has been received or pay for the service at the time of visit.

*THIS IS NOT AN ALL-INCLUSIVE LIST. MANY MORE CARRIERS HAVE INDEMNITY PLANS THAT ACCEPT CNS. WE WILL UPDATE THE LIST AS WE BECOME ACCEPTED INTO ADDITIONAL NETWORKS.