Patient Forms

Parent/Guardian MUST accompany patient to first appointment. If they are unable, all new patient forms MUST BE COMPLETED and SIGNED BY GUARDIAN and sent with a consent allowing adult accompanying child to visit. Patients will NOT BE SEEN without this information.
PLEASE BRING ALL PREVIOUS MEDICAL RECORDS TO YOUR APPOINTMENT. Call 561-753-8888 x 1613 to determine what records may be needed.

Welcome to Pediatric Neurologists of Palm Beach. We understand that it can be a very difficult time when your child needs to see a neurologist and we hope to make your experience as comfortable as possible. Consider coming a little early to your appointment in case there are problems with your referral, insurance or extra paper work.

To help make your appointment run smoothly, please take a few moments to:

1. Review our website, particularly the FAQ’s section.

2. Print, fill out and bring the following forms to your appointment.

Please print, fill out and bring the following forms to your appointment.
New Patient Forms

Spanish Forms

Por favor imprimir, llenar y traiga los formularios a tu cita.
Formularios para Paciente Nuevos

3. Make sure you have obtained any necessary referrals from your primary care physician

4. Patient insurance card and parent/guardian photo ID. It is required for new patients to be seen and Insurance Card on all patients with any insurance changes.

5. Make sure you bring your driver’s license, insurance card, co payment and any pertinent medical records or test results to your appointment.

6. If a legal guardian will not be at the visit, please bring a letter signed by the legal guardian giving permission for someone else to bring the patient.

7. Make sure you verify at which of our 3 offices your appointment is scheduled.

8. If you cannot make your appointment, please call to cancel as soon as possible.