Patient Forms

What Forms Do New Neurology Patients Need to Complete?

New patients at Charis Neurology are asked to complete a set of patient intake forms before their first appointment. These forms allow our neurologists to review your medical history, medications, prior testing, and insurance information in advance—helping ensure a focused, efficient, and meaningful consultation.

Completing your forms ahead of time reduces delays and allows for more time to discuss your symptoms, diagnosis, and treatment options during your visit.

Required Patient Forms

Please review and complete all applicable forms prior to your appointment.

Notice of Privacy Practices

This document describes how medical information about you may be used and disclosed and explains your rights regarding access to your protected health information. Patients are encouraged to review this notice carefully.

Download: Notice of Privacy Practices (PDF)
Spanish: Aviso de prácticas de privacidad (PDF)

Authorization for Release of Medical Information

This form allows patients to authorize the disclosure of their medical information to a designated individual, company, agency, or healthcare facility, when applicable.

Download: Authorization for Release of Medical Information (PDF)
Spanish: Autorización De HIPAA Para Divulgar Información Del Paciente (PDF)

Authorization and Consent for Treatment

All patients must complete this form to provide consent for medical treatment, communication via phone, email, and text message, and acknowledgment of financial responsibility for services received.

Download: Authorization and Consent for Treatment (PDF)
Spanish: Autorización y Consentimiento Para el Tratamiento (PDF)

Preferred Contacts

Patients are encouraged, but not required, to complete this form to designate preferred contacts for communication related to their care.

Download: Preferred Contacts Form (PDF)
Spanish: Contactos Preferidos (PDF)

Financial Policy

This form explains the patient’s financial responsibility for medical services provided, regardless of insurance eligibility or coverage determinations. Reviewing this policy in advance helps prevent billing misunderstandings.

Download: Financial Policy (PDF)
Spanish: Política Financiera (PDF)

Language Services

Charis Neurology is committed to providing meaningful access to care for all patients, including individuals with limited English proficiency. Language assistance services are available at no cost to patients and are provided upon request. Please contact our office if language support is needed for your visit.

For additional information, please review the Notice of Nondiscrimination.

How to Prepare for Your Neurology Appointment

To help ensure a smooth and efficient visit, we recommend the following:

• Review and complete all required patient forms in advance

• Bring a valid photo ID and insurance card

• Bring a current list of medications and dosages

• Bring prior neurological imaging or test results (MRI, CT, EEG), if available

• Arrive at least 15 minutes early if forms were not reviewed ahead of time

Preparing ahead allows your provider to focus on understanding your symptoms, diagnosis, and treatment plan.

New Patient Information

If this is your first visit to Charis Neurology, please review our New Patient Information page for details on scheduling, referrals, and what to expect during your initial consultation.

Serving Central Florida Neurology Patients

Charis Neurology is located in Lake Mary, Florida and serves patients across Central Florida, including Sanford, Longwood, Heathrow, Oviedo, Winter Park, and surrounding communities. Our patient forms support comprehensive neurological care, including general neurology and advanced subspecialty services such as neuro-oncology.

For questions about patient forms or language services, please contact our office prior to your appointment.

Frequently asked questions

Do I need to complete patient forms before my first visit?

Yes. Reviewing and completing patient forms before your appointment helps reduce delays and allows your provider to focus on your care.

Are patient forms available in Spanish?

Yes. Select forms are available in Spanish, including Authorization and Consent for Treatment and Preferred Contacts.

What happens if I don’t complete forms ahead of time?

Patients who arrive without completed forms may be asked to arrive early or may experience delays during check-in.

Can someone else receive my medical information?

Medical information is only shared with individuals or organizations that you authorize through the Authorization for Release of Medical Information form.