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Empire Neurology, P.C.

Forms

Downloadable forms for new patients:
 
You can download and print the new patient intake forms for new patients based on your ailment directly to your computer.
 

NEW PATIENT FORMS
1.  Patients diagnosed with Multiple Sclerosis

For our new MS patients, please visit our new website to download the forms

2. Patients diagnosed with Alzheimers Disease and memory issues

Your packet should include the new patient form (Form 1) and the Memory/AD form given below. Please print and fill these two (2) forms completely and mail to our office address or fax at 518-785-5000 before your very first appointment with the doctor(s).

Click here to download new patient packet 1

Click here to download AD/Memory Packet

3. Patients diagnosed with Headache issues

Your packet should include the new patient form (Form 1) and the Headache form. Please print and fill these two (2) forms given below completely and mail to our office address or fax at 518-785-5000 before your very first appointment with the doctor(s).

Click here to download new patient packet 1

click here to download Headache form

4. Patients whose ailment has not been diagnosed yet or confirmed. 

Your packet should include only the new patient form (Form 1). Please print and fill this form completely and mail to our office address given below or fax at 518-785-5000 before your very first appointment with the doctor(s).

Click here to download new patient packet 1

Empire Neurology P.C
Riverhill Center, Suite 105, 1205 Troy-Schenectady Road, Latham, NY 12110    
(518) 785-1000