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Please provide as much information as possible about why you are seeking neurological services. Suggestions include your symptoms, prior diagnoses, previous providers, any treatments you have had for your condition, and who referred you.
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Please upload any patient records you would like to provide here. Alternatively, you can fax documents securely to 800-853-0899.
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Accepted file types: pdf, Max. file size: 100 MB.
What comes next? We will review the information provided and contact you by email to notify of your acceptance, give you access to our online portal for scheduling, and provide your fee schedule. We may request further information to assist our decision. In uncommon situations, we may determine that your case is not suitable for our services and we will gladly suggest providers who can help you.
