New Patient

Welcome to the Center for Neurology and Neurophysiology, P.A.

The new patient packet, is an online form containing pages to document your patient history, previous medical information, a privacy notice, a medical release consent form and informed consent forms.

Please pay special attention to your current medications and include dosage and frequency in the medication section.

To ensure you are seen in a timely manner, these forms should be completed prior to your appointment.  Once you have completed filling out the packet on your computer, tablet or smartphone you will submit the forms electronically. You will have the option to save a copy for your records.

As a first-time patient, please show up twenty minutes early to your appointment.

New Patient Packet

New Patient Packet

Please complete the New Patient Packet if you are being seen for a neurological issue other than for headaches.

Paquete para Pacientes Nuevo En Español

Por favor complete el Paquete de Neuvo Pacientes, llegue 20 minutos antes de su cita.

New Headache Patient Packet
New Headache Patient Packet

Please complete the New Headache Patient Packet if you are being seen for migraines, chronic migraines or headaches.

Documents for The Center for Neurology

Enter your name and date of birth. Then check all the appropriate boxes. Choose Files to select the document, then press Form Attachment to upload the document. You may remove the file by pressing X next to the file.


You may upload up to ten files. (.jpg,.png,.bmp,.tif,.pdf)

COVID-19 Protocol
  • Patients must wear a mask while in the clinic.
  • We are a touch-less clinic, all documents, forms, and payments are taken online.
  • Only the patient is allowed in the exam room other participants will participate remotely on or off site.
  • The patient will be asked to remain in their vehicle until their visit begins in-person.
  • All individuals entering the clinic must complete a COVID-19 screener and have their temperature taken.
COVID-19 Precautionary Information - Center for Disease Control (CDC)
Medical Release Form

Medical Release Form – Records needed for continuing care purposes will be sent directly to the physician we refer you to upon their request.

For all other providers, our office requires a signed Medical Release Form.

Requests for medical records for reasons other than continuing care require a $25 Medical Request Fee paid in advance of your request.

EMG Referral Form

EMG Referral Form – A number of disorders are better identified and more effectively diagnosed using Electromyography and Nerve Conduction Studies in conjunction with Magnetic Resonance Imaging (MRI). Please consider referring your patients for EMG/NCS testing to help you deliver an accurate diagnosis in confidence. Our Board Certified Neurologist is fellowship trained in neurophysiology.

FMLA / Disability Form

FMLA/Disability Form – Please complete the request form and make the appropriate payment. Payment is required prior to starting your request. Any information that should be included must be in this form. Any change in language or addendum will require a new form and fee. 

Participating Insurance

We are continuously adding new insurance carriers to our list. If your insurance provider is not listed here please call us at (214) 494-4424 ext 2 to speak with one of our staff members about your particular insurance type.

  • Aetna HMO/PPO
  • Aetna Medicare – HMO with a referral
  • Baylor Scott and White Aetna
  • Baylor Scott and White BCBS
  • Baylor Scott and White Employee Plan – CIGNA
  • Baylor Scott and White HMO/PPO
  • Baylor Scott and White Baylor Quality Alliance (BQA)
  • Beech Street PPO
  • Blue Cross Blueshield PPO/POS/HMO/HMO Exchange Plan
  • Blue Advantage; Blue Choice PPO; BlueOptions; Blue Essentials (fomerly HMO Blue Texas); Blue Essentials
  • Access
  • Bravo Health Medicare Care Improvement Plus
  • ChoiceCare (Humana) Concentric Network
  • ChoiceCare (Humana) Medicare
  • Medicare Advantage
  • ChoiceCare (Humana) HMO/PPO
  • Choicecare Medicare Advantage PFFS
  • Cigna HMO/PPO
  • Cigna Local Plus (Dr Ulrich)
  • FirstHealth/Coventry Network PPO
  • FirstHealth/Coventry Medicare Advantage
  • Galaxy Health Network PPO
  • Galaxy Health Network Medical Savings Card
  • HealthSmart PPO-POS / Accel-GEPO
  • Independent Medical Systems
  • Medicare as a Non-Participating Provider
  • Medicare Railroad
  • Molina Exchange Plan
  • PacifiCare
  • PlanVista Solutions PPO
  • Texas True Choice PPO
  • United Healthcare and Affiliates HMO/PPO
  • United Healthcare Charter
  • United Healthcare and Affiliates Medicare
  • Ambetter Exchange Plan
  • Ambetter Medicaid
  • Aetna QHP
  • Medicaid
  • Molina Medicaid
  • Optum Health
  • Oscar
  • Texas Health Aetna
HIPAA notice



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SPG Block 

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Nerve Conduction Studies

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Multiple Sclerosis

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Carpal Tunnel 

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Muscle Trigger Points 

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Ambulatory EEG

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VNS Therapy

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DBS Therapy

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Post Stroke Treatment

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7000 Parkwood Blvd, Ste F100
Frisco, TX 75034
CALL US 214-494-4424

Fax: 214-494-4423
109 River Oaks Drive, Ste 150
Southlake, TX 76092
CALL US 817-379-9922
Fax: 817-379-9998

© Copyright 2020 | CNN Texas 

The Center for Neurology and Neurophysiology, PA, Frisco, TX

Phone (new patient appointments): 214-494-4424 ext 2 | Fax: 214-494-4423

Address: 7000 Parkwood Blvd, F100, Frisco, TX 75034
The Center for Neurology and Neurophysiology, PA, Southlake, TX

Phone (new patient appointments): 817-379-9922 ext 2 | Fax: 817-379-9998

Address: 109 River Oaks Dr., Suite 150, Southlake, TX 76092
The Center for Neurology and Neurophysiology, PA, Dallas, TX

Phone (new patient appointments): 469-870-7566 ext 2 | Fax: 469-519-6206

Address: 2701 S Hampton Rd, Fl 200, DallasTX 75224