Medical Forms and Additional Documents

If possible, please complete the new patient information forms on this page prior to your first appointment at Tyler Headache Center. These documents are in Adobe PDF format. If you cannot read PDF files, you can Download Acrobat Reader free from Adobe.

HIPAA Authorization Form

Patient health information is protected by law. This form gives us consent to use your health information to provide you with the best care possible and obtain insurance reimbursement on your behalf.

Head Health History Form

This questionnaire collects vital information about your head health history, including issues that pertain to dental work and dental forces, pain symptoms and locations, accident trauma, habits & lifestyle.

Headache History Form

This questionnaire collects vital information regarding your health history as it pertains to headache conditions, diagnoses and testing you have received in the past, your habits, any medication use, and more.

New Patient Intake Form

This form is used to compile contact information for you and your spouse (if applicable), emergency information, as well as dental and medical history.

Notice of Privacy Practices

We encourage you to review this document carefully as it describes how your health information may be used and disclosed, and how you can acquire access to this information. The privacy of your health information is extremely important to us!