First Time Patients

Patients are asked to gather all the information they think may be relevant to their medical care for review by the doctor prior to the visit. This could include other doctor’s notes, radiology reports and films (including Xrays, MRIs, CT scans) and current medication. Please bring with any current list of medications or even the bottles of medications, if possible. Patients are requested to ask any family interested in their condition to join them for the initial and subsequent visits – information passed along after the visit can be inaccurate, and many times family can provide information very useful to the doctor regarding the patient’s condition.

Many insurance plans require referrals for our office to be able to see you under their guidelines. Many primary care offices will not accept our requests for referrals but insist that this be arranged directly with their patients. The doctor will always see you for your visit, but you bear the cost for the visit if a referral cannot be obtained for your visit. This responsibility rests with all patients. Referrals apply to all aspects of this office and separate referrals are often required for follow-up visits, for physical therapy and for various testing procedures performed.

Please write out a list of questions you may have about your illness prior to your visit and please make sure you understand all aspects of the doctor’s plan and thoughts about your illness after the visit. Please do not leave the office with any unanswered questions and make sure you clearly understand medications prescribed and how to take them, in addition to the testing planned and the reason for the testing. Repeat visits are scheduled with timing dependent on a number of factors – if you have any questions regarding the timing of planned follow-up visits please inquire at the time the appointment is being made. This office requires at least 48 hours notice on any cancellation of an appointment to enable us to reschedule another patient in your slot.

Follow-up Visits

Please indicate any changes that may have occurred since your last visit including other doctors seen, medication changes (dosing, new drugs, drugs stopped, any herbal or nutraceutical products taken). Please let the receptionist know when you first arrive about any test results you expect to go over at your follow-up visit to guarantee that all the results have been obtained before you see the doctor. You are responsible for referrals necessary for all follow-up visits. This office requires at least 48 hours notice on any cancellation of an appointment to enable us to reschedule another patient in your slot.

Physical Therapy Visits

Our physical therapist rarely has a waiting time of more than 15 minutes. Please announce yourself to the receptionist when you first arrive as patients can sometimes be “missed” if they merely sign-in. If you find that your wait seems too lengthy make please sure the front desk personnel know that you have arrived.

Testing Pre-Authorization

This office will often be required by your insurance carrier to obtain pre-authorization for many tests, including MRIs that are ordered during our visits. Many insurance companies have up to a 48 hour processing time, and we often cannot begin the process for 24-48 hours after your visit. We try to obtain these pre-authorizations as quickly as possible, but appreciate your understanding of the complexity of the requirements of the insurance carriers. We also make every effort to expedite MRIs where there is a legitimate medical urgency.

Testing Reporting Policy

This office does not routinely call patients when test results are negative. This office will always call a patient with abnormal results. If the results are straightforward – they will be explained by phone with the appropriate plan explained. If results are complex you will be asked to meet with the doctor in person to discuss the results, their meaning, and a plan of action

Prescription Refills

The doctor will often prescribe 2 or 3 refills of medication with the initial prescription. If you need additional refills, we require at least 72 hours advance notice. This office is not able to honor emergency requests for prescription refills, so please make sure you request refills in a timely manner. We are committed to working with all of our patients to make sure they never run out of the medications they need, but we do require advance notice to ensure that your medication is available when necessary.

EMG/NCV Testing
Two one-hour tests

NCV (Nerve Conduction Velocity) Studies are done by a neurodiagnostic technician and take between 25-40 minutes to complete. This tests the speed of nerve conduction in either the arms or legs by applying low level impulses to nerves in the arms or legs and recorded the speed of the response.

EMG (Electromyography) is performed by the neurologist and studies nerve by recording feedback from muscles by use of a small probe that acts as a muscle microphone. These two tests are generally considered a single test and are usually done the same day back-to-back. Abnormalities in nerves pass along to the muscle and can be heard as abnormalities. The test will consist of either upper or lower studies – insurance companies will not allow for combined studies on the same day. Allow another 15-20 minutes for test preparation and follow-up forms.

Do not apply lotion to the arms or legs the day of the test as this can affect the results of the testing. The doctor will briefly review the results of the testing at the time it’s completed, but full discussion will require a more detailed analysis that will occur by the next follow-up visit. At that time the doctor can spend more time with you to give you a comprehensive review of the test results and their meaning.

AS THE EMG/NCV TESTING REQUIRES 1 HOUR IT IS IMPERATIVE THAT YOU KEEP THIS APPOINTMENT. ANY CANCELLATION MUST OCCUR PRIOR TO 48 HOURS TO ENABLE THE OFFICE THE UTILIZE THE TIME APPROPRIATELY FOR THOSE WHO ARE IN NEED OF THE SAME TESTING.

SSEP (Somatosensory Evoked Response) Testing
Two 30-minute tests

Much like EMG/NCV testing, these tests look for abnormalities of nerve and nerve conduction velocity. There is both an upper and lower extremity version of this test; each component takes at least 30 minutes. Similar to the EMG/NCV testing you are asked not to wear lotion the day of the test. This test is performed by a neurodiagnostic technician.

BAER (Brainstem Auditory Evoked Response) Testing
45 minutes

This test examines the integrity of the brainstem auditory and vestibular system. This test helps to sort out whether dizziness, ringing in the ears and spinning sensation (vertigo) is coming from a problem with the brain (as in a small stroke) or from the outer or inner ear. The test consists of a series of clicks you will hear wearing headphones – similar to audiology testing with a similar set of electrodes on your head attached to a portable walkman sized-box that is then reviewed after 24-48 hours enabling a larger chunk of time to be evaluated including sleep time. This study takes about 45 minutes. This test is performed by a neurodiagnostic technician

Carotid Doppler Ultrasound Studies
10 – 15 minutes

This study looks for any blockage of the internal carotid arteries that go to the brain. Blockages can lead to strokes and at times cause blackouts of fleeting blindness. The testing uses ultrasound to painlessly evaluate the possibility of blockage in these arteries. This test is performed by a neurovascular technician. This test takes 10-15 minutes.

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