Central Texas Neurology Consultants (512)218-1222
Call for Appointment (512) 218-1222
Monday - Friday 8:00 am - 5:00 pm
  • Home
  • About Us
    • Mission Statement
    • Administrative Team
    • Clinical Team
    • Physical Therapy Team
    • What's a Neurologist?
    • News and Announcements
  • Our Providers
    • Edward J. Fox, MD, PhD
    • Craig H. Couch, MD
    • Adam D. Horvit, MD
    • Terry S. Peery, DO
    • Elizabeth L. Peckham, DO
    • Stephanie Agrella, PhD, APN-BC
  • Services
    • Headache Center
    • Center for Sleep Medicine
    • Multiple Sclerosis Clinic
    • Epilepsy Center
    • Neuromuscular Center
    • Movement Disorder Center
    • Memory Disorders Clinic
    • Electrodiagnostic Center (EMG and EEG)
    • Clinical Research Center >
      • Our Current Clinical Trials
    • Infusion Center
    • Physical Therapy
  • Patient Resources
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    • Billing Information
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Medical Records Request Form
As a new patient at CTNC you will be required to fill out multiple forms prior to your visit. This will include a "New Patient Packet", in addition to the appropriate "Health History Questionnaire".  The "New Patient Packet" includes a welcome letter, demographics, authorizations and our HIPAA privacy policy. There are various "Health History Questionnaires" specific to the problem you are seeing us for, and are designed to obtain a detailed medical history.

We are better prepared for your visit when you arrive at least 30 minutes early with your forms already filled out. This will allow ample time for our staff to enter your medical history, medications and insurance information into our electronic medical record before your appointment. If you do not arrive 30 minutes early with your forms already filled out then we may not be able to see you in a timely manner and, in some instances, may have to reschedule your appointment.


Please do not forget to bring the completed forms with you to your appointment.

Additional items to bring to your appointment:
  • Photo ID
  • Your current insurance card
  • Any test results, x-rays, MRIs or other radiographic studies that have been performed
  • Your copayment or coinsurance

Please download and complete the "New Patient Packet" and appropriate "Health History Questionnaire" associated with the doctor you are scheduled to see.
Edward J. Fox, Md, PhD - Multiple Sclerosis​
Dr. Fox Patient Forms (click here)
Craig H. Couch, MD - Headaches and General Neurology
Dr. Couch Patient Forms (click here)
​Adam D. Horvit, MD - Neuromuscular Disorders and General Neurology
Dr. Horvit Patient Forms (click here)
Terry S. Peery, DO - Epilepsy, Sleep Medicine and General Neurology
Dr. Peery Patient Forms (click here)
​Elizabeth L. Peckham, DO - Movement Disorders and General Neurology
Dr. Peckham Patient Forms (click here)

​If you are unsure which Health Questionnaire to complete or have other questions about the registration process, please call our office at (512)218-1222 and ask for new patient scheduling.

Schedule your appointment today.
- call us at -
512-218-1222
16040 Park Valley Dr, Building B, Suite 100  |  Round Rock, TX 78681  |  Phone: (512)218-1222  |  Fax: (512)218-1393
Copyright ©2014 | Central Texas Neurology Consultants, PA
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