New-Patient Resources

New-Patient Paperwork:

The following paperwork must be completed prior to your first visit with Neurosurgical Associates, LLC. Please complete and bring the following forms with you on the date of your visit. Please contact us at 801-507-9555 if you have any questions or require assistance with the paperwork.

• New Patient Form
• Arbitration Agreement
• Arbitration Brochure
• Privacy Notice Policy
• Neurosurgical Associates Brochure
• Map to Murray Office
  
• Map to Park City Office
  

New-Patient Appointments:

To request a consultation with a member of Neurosurgical Associates, LLC please fill out the following form. As a specialty center, we accept new patients only after an initial work up, including MRI, has been done by your primary care or family physician. An MRI done within the past 6 months must be reviewed by the neurosurgeon in order to determine if a neurosurgical consultation is warranted. We will contact you directly within one week to let you know if an appointment can be scheduled.

• MRI Check-In Form
  

Referring Physician Information:

Thank you for considering Neurosurgical Associates, LLC for the care of your patient. To refer a patient, please complete the following Physician Referral Form. Please fax the form and all related clinic notes and diagnostic reports to 801-507-9550. The information submitted will be reviewed by the neurosurgeon of your choice, or the next available surgeon if a specific surgeon is not chosen. The patient will be contacted regarding an appointment.

• Appointment Request Fax Cover Sheet
  
• Consultation / Referral Form