Forms and Printouts
Patient Forms
Printable forms and documentation to help inform patients of policies, procedures, and to help expedite office visits.
Documents are in PDF format. In order to view these files, a PDF reader such as Adobe Acrobat Reader is required. Most modern web browsers support PDF files natively, but you may prefer a stand-alone application such as Adobe's Acrobat Reader. The following link will open in a new window and direct you to the proper download for your device. Mobile users will be directed to their respective app stores from the Adobe website. Get Acrobat Reader
HIPAA Notice of Privacy Practices Required Form
Description
Oxford Neurology Clinic's HIPAA Notice of Privacy Practices. This document describes how your Protected Health Information (PHI) is used and disclosed. It also defines your rights to access and control your PHI.
The Notice of Privacy Practices Acknowledgment Form signifies that a patient has received a copy of, and is in agreement with, Oxford Neurology Clinic's HIPAA Notice of Privacy Practices. This is a required form for all patients.
Directions
- Print both files or download to your computer to print later
- Read the HIPAA Notice of Privacy Practices (This is your copy to keep)
- Complete and Sign the Notice of Privacy Practices Acknowledgment Form *all fields are required (Return this form)
- Mail the form or bring it on your next appointment: Oxford Neurology Clinic 2908 S. Lamar Boulevard Suite 100 Oxford, MS 38655
Files
New Patient Forms Required Form
Description
Forms for new patients. Completing these forms and returning them to Oxford Neurology Clinic prior to your appointment date will greatly reduce the amount of time you spend filling out paperwork in the waiting room, making your overall appointment time much quicker.
Directions
- Print the forms or download to your computer to print later
- Read the forms carefully and fill out as much information as possible. If the patient is a minor or unable to complete the forms, a legal guardian may complete and sign for them. *all fields are required (Return this form)
- Mail the form or bring it on your next appointment: Oxford Neurology Clinic 2908 S. Lamar Boulevard Suite 100 Oxford, MS 38655
Files
Referral Form
Description
This is a patient referral form for physicians.
Directions
- Print the form or download to your computer to print later
- Complete and send the form by mail or fax: Oxford Neurology Clinic 2908 S. Lamar BoulevardSuite 100 Oxford, MS 38655-or-Fax: (662) 281-0943
Files
SMS Reminder Consent Form Required Form
Description
This is a consent form allowing us to remind patients about upcoming appointments via text message.
Directions
- Print the form or download to your computer to print later
- Complete and sign the form *all fields are required (Return this form)
- Mail the form or bring it on your next appointment: Oxford Neurology Clinic 2908 S. Lamar Boulevard Suite 100 Oxford, MS 38655
Files