If you are interested in becoming a patient at Gazda Integrative Neurology, and are located in Texas or Colorado, please complete the new patient inquiry form below and we’ll be in touch shortly. You may also contact us at (210) 853-3967 to speak with a staff member. Please do not send any personally identifying information or details specific to your health or current prescriptions via this form.

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Downloadable Patient Forms

Package of forms for ADULT patients only.
Download and complete these fillable forms.
You can submit completed forms directly using the “submit" button, or save and attach the forms to your own email and send to:
info@gazdaintegrativeneurology.com

ADULT PATIENT FORMS.zip
File Size:	1310 kb
File Type:	zip

Download File

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Package of forms for PEDIATRIC patients only.
Referrals limited at present to patients 12 years of age and older. Download and complete these fillable forms. You can submit completed forms directly using the “submit" button, or save and attach the forms to your own email and send to:
info@gazdaintegrativeneurology.com

PEDIATRIC PATIENT FORMS.zip
File Size:	656 kb
File Type:	zip

Download File

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All forms are available individually below.

Adult Patient Questionnaire.pdf
File Size:	2055 kb
File Type:	pdf

Download File

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Pans & Pandas-Childrens Intake Questionnaire.pdf
File Size:	571 kb
File Type:	pdf

Download File

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Patient Information Fillable.pdf
File Size:	87 kb
File Type:	pdf

Download File

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Consent to Treat Fillable Form.pdf
File Size:	37 kb
File Type:	pdf

Download File

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HIPAA NOTICE.pdf
File Size:	51 kb
File Type:	pdf

Download File

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Patient Notices.pdf
File Size:	44 kb
File Type:	pdf

Download File

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Patient Office Policies.pdf
File Size:	62 kb
File Type:	pdf

Download File

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Privacy Practices.pdf
File Size:	70 kb
File Type:	pdf

Download File

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