Forms and Instructions

New Patient Forms Kansas

• • • New patient paperwork Lenexa 061717  Print out and Complete before your first appointment at RNI to save time in the office

OR fill out online before printing out

• • • Digital fill New patient paperwork Lenexa 04182017  Complete online and print out before your first visit at RNI to save time.
    • Notice of Privacy Practices – Kansas
    • Notice of Privacy Practices – Missouri

New Patient Forms California

• • • New patient paperwork California 092117  Print out and Complete before your first appointment at RNI to save time in the office–email or fax, or bring with you

OR fill out online before printing out

• • • New patient paperwork LA 091317 Digital fill Complete online and print out before your first visit at RNI to save time.

Imaging

• • • MRI Instructions & Information
    • MRI Questionnaire (form)

Sleep Disorders

• • • Sleep Disorders Testing Information
    • Sleepiness questionnaire
    • Epworth Sleepiness Scale Survey
    • Sleep Log – track your sleep day-to-day, for your own information and to help the doctors’ understanding.
    • Multiple Sleep Latency Test Information

Headache

• • • Headache Questionnaire
    • 2015 Botox Information Packet
    • 2017-Headache Diary
    • 2018-Monthly- Headache Diary

Neurophysiology

• • • EMG and NCS
    • EEG
    • Blink Reflex and Facial Nerve Testing
    • Evoked Potential Testing
    • Lumbar Puncture Information

Physical Therapy

• • • Physical Therapy New Patient Paperwork (form)
    • Physical Therapy Information

Neuropsychology

• • • Neuropsychology Information

ADMINISTRATIVE

Administrative Forms

• • • Authorization for RNI to Release Medical Records (TO another provider) (form)
    • Authorization to have Medical Records Released to RNI (FROM another provider) (form)
    • FMLA and Disability Policy (form) 052218
    • Credit Policy and Authorization (form)

Other forms & instructions

Patient satisfaction survey

Epworth Sleepiness Scale

Headache questionnaire

Holter Monitor Instructions

Lumbar puncture information

Myelogram-CT scan instructions

Multiple sleep latency test instructions

Somatosensory evoked potential instructions

Referrals

We welcome referrals from other medical professionals.

Referral Form

Our policies

Test results

Refills

Payment