Patient Forms

PATIENT FORMS

FOR ALL NEW PATIENTS - Please fill out and print the new patient registration form and the appropriate clinical questionnaire. You may email them to clinicrotenberg@houstonspecialtyclinic.com.

Completing forms in advance will speed your visit on the day of your appointment. 

Please also review our office policies and consents. You can sign these forms electronically in the office.

New Patient Forms

• New Patient Packet
• Medical Records Release
• Neurology New Patient Forms
• Neurology Headache Diary
• Neurology Pediatric Headache Disability Scale (PedMIDAS)
• Pulmonary New Patient Forms
• Pediatric Sleep New Patient Questionnaire
• Adult Sleep New Patient Questionnaire

Established Patient Forms 

Neurology

• Neurology Follow Up Visit Form

Pulmonary

• Childhood Asthma Control Test for children 4 to 11 years old
• Asthma Control TestTM for teens 12 years and older

Chronic Care

• Forms coming soon!

HIPAA Compliance

• HSC HIPAA