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Forms to fill out prior to your initial visit

You can streamline your initial visit by printing and filling out these forms and then bring them with you.


Neurologique Foundation, Inc. (Neurologique) is a nonprofit organization dedication to patient-centered care, research and education.

We intend to offer factual, up-to-date news and information, answers to questions on relevant subjects, and informed opinion. The information is not and should not be regarded as a complete analysis of these subjects. The reader should consult physicians or other medical professionals prior to making any diagnostic, treatment, or other health care decisions. In no case should someone make any changes to current therapy based on the information presented on the Neurologique site or any other web site without first consulting with a competent physician or other qualified health care provider.

Health professionals reading the provided information should consult primary sources and the official, complete prescribing information before making any treatment decisions, including the use of any drug or other product referred to on this site.

In its information, Neurologique may offer news, reports, or other information concerning drugs, dosages, indications, usages, biological compounds or agents, devices, or treatments that are not now approved for use in the United States or elsewhere and may never be approved. Neurologique does not advocate or recommend adopting any treatment modality based solely on any of the information provided. Again, it is the responsibility of the reader to consult with qualified health professionals before making any diagnostic, treatment, or other health care decisions. Similarly, it is the responsibility of any health care professional to refer to the full prescribing information before making any treatment decisions regarding their patients.

No party associated in any way with this site or its contents assumes liability for any injury, loss, or damage resulting from the use or misuse of any information contained herein or for any errors or omissions. Neurologique, any sponsor, provider of content, or referenced source cannot be held responsible for the validity of the information contained herein, nor for the use or misuse of information or for any adverse effects that may result from use of any information or materials presented herein; nor for any direct or consequential damages.

Neurologique does not offer medical advice. Readers should seek medical advice from a licensed physician or other qualified health care professional and not rely on information they may gather from secondary sources such as the internet.

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Neurologique respects the privacy of patients and visitors who use our website. Any information that an individual submits on a voluntary basis will be used for the sole purpose for which it is submitted.