NORTHWEST HOUSTON NEUROLOGY 281.357.5678

Our goal is to provide quality medical care and to maintain a positive patient-physician relationship.  Providing you with our office policy in advance encourages the flow of communication and enables us to achieve our goal.  Please review our policy carefully.

Appointments

  • All patients must complete the patient information forms prior to seeing the physician.  We will require copies of your insurance card and photo identification. You may be asked to update this information annually.
  • If you arrive more than 15 minutes late for your appointment, you may be asked to reschedule your appointment.
  • We value the time we have set aside to spend with you. If you are unable to keep an appointment, please provide a 24 hour notice so that we may offer this time to another patient. If you do not provide notice, we may charge a $50 No Show Fee for regular appointments, or a $75 No Show Fee for procedures. Failure to comply with our cancellation policy can lead to dismissal from the practice.

Financial Policy 

Payment in full is due at the time services are rendered, including past due balances.

  • Any patient share estimates (copayments, deductibles, co-insurances) are due in full at the time of service. An estimate is only an estimate and never a guarantee of exact fees. Your final share will be determined once the insurance processes the claims. 
    • Patient overpayments will be refunded within 30 days of the request.
  • Our office verifies insurance coverage as a courtesy; however, payment is not guaranteed claims are processed by the insurance company. It is the insured’s responsibility to understand the benefit plan with regards to covered services and participating facilities. The patient will be billed directly for any services not covered by insurance. 
  • If our office is unable to verify the insurance coverage, the patient is financially responsible for the visit. 
  • It is your responsibility to update us with current insurance information. If the insurance company you designate is incorrect, you may be held responsible for charges due to timely filing requirements. 
  • If the insurance company requires a referral and one is not on file, the patient is financially responsible for the visit.
  • We are happy to help assist with insurance questions. However, specific coverage issues or claims processing questions should be directed directly to your insurance company. 

We do not file claims to the following (see below). The patient is responsible for payment in full. We will provide receipts so that you may file claims for reimbursement. 

  • Secondary Insurances (Medicare is an exception)
  • Worker’s Compensation
  • Automobile Insurance

Your insurance company may request that you supply information to them directly in order to process claims (i.e. coordination of benefits, pre-existing info.). It is your responsibility to comply in a timely manner. 

If the patient is a minor, in cases of divorce or separation, the person requesting services is responsible for the payment due at the time of service and for any past due balance. 

We accept cash, check, Visa, and MasterCard. A $30 fee will be assessed for returned checks. Checks returned due to stop payment may lead to dismissal from the practice. 

Statement are sent out monthly and payment is appreciated within 10 days upon receipt. Accounts with balances over 90 days with no activity can be turned over to collections and dismissed from our practice. 

Authorizations / Prescriptions and Refills

Some tests ordered by our physicians may require authorization from your insurance carrier. If this is the case, please allow 10 business days for our office to obtain the authorization. 

Prescriptions and Refills:

  • We do not dispense written prescriptions. We will send prescriptions electronically or call-in prescriptions directly to the pharmacy.
  • Controlled Substances
    • Controlled substance prescriptions cannot be sent electronically to the pharmacy. We will call-in these prescriptions when applicable.
    • Some controlled substances cannot be called-in to the pharmacy and must be picked up from the office by an authorized person over the age of 18.
    • These prescriptions require monthly or quarterly visits with the physician.

Forms

  • Forms will be completed during an appointment. Please bring forms to the visit and complete everything other than the section required by the physician. We reserve the right to decline completion of these types of forms. 
  • There is a $25 fee for medical letters written by physicians. 

Transfer of Records

A $25 fee will be assessed for a copy of your medical records. A release of information must be signed. If you transfer to another physician or we refer you to another physician, we will send that physician a copy of your last visit and pertinent records free of charge. Please allow 10 business days for transfer of records.

Non Compliance with our office policy and violation of physician/patient relationship can lead to dismissal from the practice. Examples of this include noncompliance with physician orders, excessive scheduling problems, and disruptive behavior.

Office Address & Directions

TOMBALL OFFICE 

CYPRESS OFFICE

New Patient Forms

A library of downloads, links and resources to expedite patient care and provide helpful information about neurology and sleep medicine.

  • Click here to complete medical forms on our secure Portal.

OR, download and complete the appropriate new patient packet below:

  • EMG New Patient Packet EMG New Patient Packet
  • Headache New Patient Packet Headache New Patient Packet
  • Seizure New Patient Packet Seizure New Patient Packet
  • Sleep New Patient Packet Sleep11 and Older NP Packet
  • Other Reason New Patient PacketOther Reason New Patient Packet
  • Release of Records Authorization