NEURODIAGNOSTIC CONSULTANTS, LLC.

Olga O. Brusil, MD Neurology & Clinical Neurophysiology
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 PATIENT REGISTRATION 
 
Please download, fill out these forms and bring them with you to expedite the registration process at the time of your scheduled appointment. You will need to have Adobe Acrobat installed on your computer.  If you do not have Adobe Acrobat installed, please download it free of charge here.
 
If the patient is older than 18 years, or is an emancipated minor, Forms 1,2 and 4 are required.
 
If the patient is younger than 18 years at the time of appointment, Forms 1,3 and 4 are required.  All forms for such a patient have to be countersigned by a legal guardian, who will accompany the minor to the appointment.
 
Form 3 - Consent Of Guardian To Medical Care Of A Minor (if patient is younger than 18 years of age)
 
Please remember to bring one form of identification (driver's license, state identification card or passport) and medical insurance card(s).
 
 
REQUESTING MEDICAL RECORDS FROM NEURODIAGNOSTIC CONSULTANTS, LLC.
 
If you need to request your medical records from Neurodiagnostic Consultants, LLC., please complete the following form and fax it to Medical Records at (773)725-8447.