New Patient Paperwork

New Patient Paperwork

This questionnaire is for all new patients or patients who have not been seen in over 2 years who are coming into the office for a consult for Physical Medicine and Rehabilitation/Pain Management. If you are having a consult with Dr. Michael Wolff, Dr. Lata Kumaraswamy, or Ami Mikhail, M.S., PA-C.

Option 1: [Preferred Method]
Please complete online form 48 hours prior to your appointment to help our office prepare for your visit.

Option 2:
Download this paperwork and bring the completed forms with you to your appointment.

Option 3:
This paperwork is available at our front desk; however you must arrive at least 30 minutes earlier to ensure sufficient time to complete this comprehensive packet.

New Patient Paperwork for EMG/NCS

This paperwork includes a brief medical history and signature pages. If you have been referred for an Electromyogram and Nerve Conduction Studies only, and will not be transferring care to one of our physicians, please download this paperwork and bring the completed forms with you to your appointment.

Follow-Up Form

This questionnaire is required by all physicians to be completed before each scheduled office visit.* Please fill out each section completely and bring with you to your appointment. This form will also be available at the front desk upon arrival.

*EMG and Diagnostic Ultrasound appointments are not required to complete a follow-up form.

HIPAA Privacy Practices (read-only)

This read-only document outlines the notice of privacy practices for protected health information. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.