Adipex Abeliuk Medical Group » Patient Info

Jun 25th 2008 Patient Info

Your First Visit

Please confirm your appointment during the week prior to your appointment as well as the day before.

On your first visit, you will be asked to come in early to fill out forms.¬†We’ve placed all of these forms here on the website. Please click on the forms below, print out, and fill out to bring with you on the first visit. Be sure to carefully record your current symptoms and complaints. The doctor will put them into the report, so be as detailed as you can.

Patient Questionnaire

Patient Questionnaire (Spanish)

Activities of Daily Living Questionnaire

Activities of Daily Living Questionnaire (Spanish)

Re-evaluation Questionnaire

Re-evaluation Questionnaire (Spanish)

Epworth Sleepiness Scale

Epworth Sleepiness Scale (Spanish)

Please bring copies of all relevant previous medical evaluations, all of your current medications, insurance information, laboratory reports, x-ray reports, CAT scan reports, and MRI scan reports with you for your neurologist appointment.

Please make copies of your paperwork prior to your appointment. If you request our office to copy your forms or other paperwork, we charge $1.00 per page to cover our overhead.

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