New Patient Information
Visit our office or schedule an appointment: Monday through Friday. Mornings : 8 a.m. to noon. Afternoons: 2 p.m. to 5 p.m
Cancel or change an appointment: Please notify us at least 24 hours in advance.
Initial consultation: Plan on at least an hour. Please bring your new patient paperwork, insurance card, medications and previous MRI/CT films or medical records as requested when you scheduled your appointment.
Follow-up examinations: Plan on 15 to 30 minutes. We make every effort to see our patients promptly: Unfortunately, sometimes emergencies do arise, and we fall behind schedule. Your patience is greatly appreciated.
Please download the New Patient Forms PDF and complete all pages before your appointment.
All of the following forms are included in the New Patient Forms PDF:
- Patient Registration
- Patient History
- Release Authorizations
- Financial Policy
We accept many health insurance plans. For information about your plan, please contact them directly. To verify which plans are currently accepted by the Neurology and Pain Specialty Center, please call 949-305-7122.
We appreciate payment at the time of service. You are responsible for payment of all charges, regardless of your insurance coverage.
We accept most HMO and PPO insurance plans and Medicare. You may also pay by personal check, MasterCard or Visa.
If you need to arrange a payment plan, please call our office at 949-305-7122 and ask for our Practice Administrator, Ann Marie Wine. She, and all of our staff members, will work with you to help you get the care you need.
If you are a Workman’s Compensation patient, you can expect exceptional care from our staff. We have handicapped-friendly exam rooms and restrooms as well as a dedicated suite to care for your procedural needs in a timely and cost-effective manner. Our office is equipped with a wireless, integrated Electronic Health Record to seamlessly and quickly expedite patient reports and authorizations.
Because of our specialized experience, we are able to facilitate closing difficult cases or to assist patients to return to work in a full or in a modified capacity with minor restrictions.
- How your medical information can be used and disclosed
- How you can get access to this information
- Your rights and our obligations regarding the use and disclosure of medical information
At the Neurology and Pain Specialty Center, we’re dedicated to protecting your medical information. To provide you with quality care and to comply with certain legal requirements, we create a record of the care and services you receive at our practice. Our records include care generated by any and all of our personnel.
HOW WE MAY USE AND/OR DISCLOSE YOUR MEDICAL INFORMATION
Treatment: Physicians, nurses, medical students, or other medical practice personnel who are involved in your care at our practice.
Payment: Treatment and services you receive at our medical practice may be billed to, and payment may be collected from, you, an insurance company, or a third party.
Practice operations: To help manage our medical practice and to help you receive quality care, we may use your information for appointment reminders, treatment alternatives, and health-related benefits and services.
Research: With your permission, we may want to include your medical information that’s important for research purposes.
Requirements of the law: When required to do so by federal, state or local law, we will release your medical information.
Averting a serious threat to your health or safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Other purposes: Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. You may revoke your permission in writing at any time.
As a patient of the Neurology and Pain Specialty Center, you may:
View and copy your medical information that may be used to make decisions about your care.
Amend your information if you feel that your medical information is incorrect or incomplete.
Receive a list of the disclosures we made of your medical information other than for our own uses for treatment, payment and health care operations.
Request a restriction or limitation on disclosure of your medical information, payment or health care operations.
Request confidential communications about medical concerns in a certain way or at a certain location.
CHANGES IN POLICIES
We reserve the right to revise or change this notice for medical information we already have about you, as well as any information we receive in the future.
If you believe your privacy rights have been compromised, call us at 949-305-7122. Or, write to:
Neurology and Pain Specialty Center
5 Journey, Suite 210
Aliso Viejo, CA 92656
If you have further issues with our handling of your concerns, you may submit a formal complaint, in writing, to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
NOTE: You will not be penalized for filing a complaint.
For more information, visit the U.S. Dept. of Health and Human Services website for more answers to your HIPAA Privacy.