Nurology Associates of Monroe County

Bring with you:
	Your insurance card
	Physician referral forms
	Current prescriptions
	Pertinent information about your medical and surgical history
	Recent MRI’s or appropriate records

Please take time to print and to fill out the pertinent forms and screening questionnaires listed below and make sure to bring the materials along with you to your appointment.

For ALL patients being seen for the first time:

Patient Demographic Info
Patient History Questionnaire
Financial Agreement
Motor Vehicle Intake Form -Should only be filled out if you are seeing the doctor for an injury from a motor vehicle accident.
Worker's Compensation Intake Form -Should only be filled out if you are seeing the doctor for a work related injury.

For all patients coming for a VNG test:

VNG Questionnaire -Should only be filled out if you are having a VNG test

For all patients being seen for a Sleep Evaluation:

Epworth Sleepiness Scale -Should only be filled out if you are having a Sleep Evaluation.

For all patients coming for a Sleep Study for the first time or if it has been over six months since you last had a Sleep Study.

Sleep Questionnaire

For more more information regarding Neurological Disorders please refer to our Services pages.