Depending on the type of insurance coverage I have, I understand that I may be required to obtain a referral from my assigned Primary Care Provider (PCP) before being seen in this office. I acknowledge that it is my responsibility to secure this referral, if needed, prior to scheduling an appointment. Should I attend my appointment without the necessary referral and my insurance denies coverage, I accept financial responsibility for the services provided during the visit.
Please note that each patient may be accompanied by one person in the exam room to promote focused care and minimize distractions for both the provider and patient.
I, the undersigned, hereby voluntarily consent to medical evaluation, diagnostic procedures, and treatment provided by Neurovations Neurology Clinic and its healthcare providers. I understand that this consent includes any necessary medical procedures or services provided as part of my care, which may include diagnostic imaging, laboratory tests, or other therapies deemed appropriate by the medical team.
I acknowledge that:
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I have the right to ask questions and discuss any aspect of my care with my provider.
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I understand that medical diagnosis and treatment involve risks and that no guarantee has been made to me regarding the outcome of my treatment.
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This consent will remain in effect for the duration of my treatment at Neurovations Neurology Clinic unless I withdraw it in writing.
By signing below, I authorize Neurovations Neurology Clinic to provide care and treatment as necessary and appropriate to my medical needs.
