Welcome to our Neurosurgery practice. To make your first visit here easier, here is a list of things that you should be prepared with and bring with you to the appointment.
NEW PATIENT INFORMATION
All forms that we require you to fill out, can be found in the "Forms" tab. Please make sure you do not leave ANY blanks, as it will not let you submit if you do. If something does not pertain to you, please put N/A. **Note this page is READ ONLY. You DO NOT need to submit this form at the bottom.**
INSURANCE INFORMATION
IF YOU HAVE WORKMEN'S COMPENSATION:
FILL OUT WORKERS COMPENSATION INFORMATION SHEET
IF YOU HAVE NO FAULT:
FILL OUT NO FAULT CLAIMANT HISTORY FORM COMPLETELY, NO FAULT INFORMATION SHEET, AND NEW YORK MOTOR VEHICLE NO FAULT INSURANCE LAW ASSIGNMENT OF BENEFITS FORM.
HMO'S
a) Co-payment is expected upfront in full, based on expected insurance reimbursement, but occasionally you may be charged subsequent fees, depending on your coinsurance/ deductible. (cash, check or credit card)
b) Bring your insurance card(s) and photo identification with you.
c) If your insurance requires a referral, please call your primary doctor to make a referral to Narendra Kansal, M.D. Please make sure your referral is in place BEFORE your appointment or the doctor WILL NOT be able to see you.
**YOU WILL NEED TO BRING WITH YOU TO YOUR APPOINTMENT:**
a) All X-rays, CT scans, or MRI FILMS or a CD disk and their reports. If you have had any of these tests done.
***IF YOU DO NOT HAVE THE FILMS or CD disk, YOU NEED TO GO TO THE FACILITY WHERE YOU HAD THEM DONE AND PHYSICALLY PICK THEM UP TO BRING THEM TO YOUR SCHEDULED APPOINTMENT.***
b) Any other information to help the doctor diagnose your case. (Ex: EMG or Discogram)
c) Please bring a complete list of all of your medications.
We look forward to your visit! Dr. Narendra Kansal and the Office Staff
***Please Note: There will be a $35.00 charge for missed appointments unless 24 hours notice is given. This fee is a personal responsibility and is not covered by insurance***
