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To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.  

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

• New Patient Packet
• General Neurology Health Questionnaire
• MS Medication Form

Craig H. Couch, MD - Headaches and General Neurology

• New Patient Packet
• General Neurology Health Questionnaire

Adam D. Horvit, MD - Neuromuscular Disorders and General Neurology

• New Patient Packet
  
• General Neurology Health Questionnaire

Terry S. Peery, DO - Epilepsy, Sleep Medicine and General Neurology

• New Patient Packet
• Sleep Disorders Health Questionnaire  (if you are seeing Dr. Peery for sleep apnea, insomnia, narcolepsy, restless leg syndrome or other sleep disorders)
• Epilepsy/Seizure Health Questionnaire (if you are seeing Dr. Peery for seizures or epilepsy)
• General Neurology Health Questionnaire  (if you are seeing Dr. Peery for something other than a sleep disorder or seizures, such as memory loss, dementia or stroke)

Elizabeth L. Peckham, DO - Movement Disorders and General Neurology

• New Patient Packet 
• Movement Disorders Health Questionnaire (if you are seeing Dr. Peckham for Parkinson's Disease, tremor, dystonia or other movement disorders)
• General Neurology Health Questionnaire  (if you are seeing Dr. Peckham for something other than a movement disorder, such as memory loss, dementia or stroke)
• Follow-up Visit Form (if you are an established patient of Dr. Peckham's, please download and fill out this form prior to your follow-up appointment)

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.

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