Patient Information

What to Bring to Your Appointment

• Your current health insurance card
• Driver license or picture I.D.
• Referral forms if required by insurance
• A list of current prescriptions or over-the-counter medications you are taking, including dose and frequency.
• Pertinent medical records including radiographic, MRI and CT films and/or test results
• Patient information forms (see below)

Patient Information Forms

If you are a new patient or have not been seen in the last twelve months, please click on the links below to download and print the forms. Bring the completed forms to your appointment. [PDF help]

• For all new patients:
  • HIPAA Compliance Patient Consent Form
  • Consent for Treatment
  • Consent for Treatment (Spanish)
  • Patient Information
  • Patient Information (Spanish)
  • Patient Chief Complaint Form
  • Patient Chief Complaint Form (Spanish)
  • Notice of Privacy Practices
• For new patients with headaches scheduled with Dr. Berrios:
  • Headache Form
  • Headache Form (Spanish)
• For new patients scheduled with Dr. Fleming:
  • Review of Systems
  • Review of Systems (Spanish)
• For new patients with vertigo/dizziness:
  • Dizziness/Vertigo Questionnaire
  • Dizziness/Vertigo Questionnaire (Spanish)

Hospital Affiliations

We are affiliated with Memorial Hermann Southwest Hospital.

Payment and Insurance

Memorial Neurological Association is a provider for Medicare and most major insurance plans. If you have any question regarding which insurance plans we accept, please contact 713.772.4600.