Please review the following information prior to your first visit to the Brain and Spine Center.
If a referral is required by your insurance, please obtain all necessary referral forms from your primary care physician in advance of your visit.
Insurance and co-payments
Please bring your insurance information and applicable co-payment. Note that most insurance plans are accepted.
Recent imaging tests
If you have had x-rays, CT scans, or MRI scans done at a facility that is not part of Main Line Health, please bring an electronic copy of the tests (disk) with you.
Please download and complete the following forms and bring them with you. Alternatively, you can mail or fax the forms to the Brain and Spine Center in advance of your visit.
- Patient registration form
- New patient evaluation
- New patient medications
- Patient signature on file form
- Patient demographic data sheet
- Instructions for authorization to disclose protected health information (PHI)
- Authorization to disclose protected health information (PHI)
- Patient financial policy form
- Main Line Health notice of privacy practices
- Acknowledgement of receipt – MLH notice of privacy practices
- Non-discrimination and availability of services notice
The office is located in the Medical Science Building in Suite 370. Please use the elevators located on the 1st floor in the Medical Science Building. Download a printable version of driving directions to the Brain and Spine Center (PDF).