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North Central Neurology Associates, P.C.

Joanne P. LaGanke MS Center

Please print and complete the following forms if you are a new patient and will be visiting us for the first time. Our office requires a copy of your insurance cards and driver's license in addition to the completed forms.

* If you are an established patient and your address, phone number or insurance information changes, please contact our office immediately so we can accurately update your contact and insurance information.

Patient Information

HIPAA Form/ Privacy Notice

Release of Medical Records

Medication Form

* Due to recent changes in our office policies, it is required that each patient update their medication list prior to being seen. *

* Please bring your most recent MRI to appointment. You can either bring the CD or have them fax it to our office at 256.739.9245*