The mission of First Choice Neurology is to improve the quality of neurological services while providing those services in a cost-effective manner to the communities we serve.
Patient Information Forms
Please print the applicable patient information forms below. Complete the forms and bring them to your first appointment.
Advance Beneficiary Notice of Non-Coverage (English)
Advance Beneficiary Notice of Non-Coverage (Spanish)
Assignment of Benefits and Financial Responsibility Form (English)
Assignment of Benefits (Spanish)
HIPAA Privacy Acknowledgement
FCN HIPAA Policy- English
FCN HIPAA Policy - Spanish
Records Release for MRI
Consent for MRI Gadolinium
Recurring Credit Card Authorization Form
Sleep Self Test Tear Off
Headaches Botox Questionnaire
Personal Item Notice
HMO Authorization Waiver
Non-discrimination and Accessibility Form
Information on Nonopioid Alternatives for the Treatment of Pain
Out of Network
We understand that seeing a doctor is only part of your medical experience. Billing and payment for health care services can be confusing and complicated. We try to help patients with insurance questions before their initial visit, so they can make an informed decision regarding their out-of-pocket costs. Please call the physician's office prior to your visit to confirm that your medical visit will be covered by your health insurance provider.
Read about Selecting the Right Health Insurance Plan by Dr. Antonio Mesa.
For a list of insurance accepted for physicians, please visit our insurance page.
For a list of insurance accepted at our MRI Centers, please visit our insurance page.
For a list of insurance accepted at our Therapy Centers, please visit our insurance page.
For a list of insurance accepted at our Infusion Centers, please visit our insurance page.
First Choice Neurology is the largest neurology group in the United States. We have offices in Aventura, Boca Raton, Coconut Creek, Coral Gables, Coral Springs, Davie, Delray Beach, Doral, Fort Lauderdale, Hollywood, Loxahatchee, Margate, Miami, Miami Beach, Midtown Miami, Palm Beach Gardens, Palmetto Bay, Pembroke Pines, Plantation, Royal Palm Beach, South Miami, Sunrise, Tampa, and Weston. First Choice Neurology's corporate office is located in Medley. Our Florida adult and pediatric Neurologists specialize in Adult Neurology, ADHD, Alzheimer’s Disease, Autism, Cerebral Palsy, Concussion, Dementia, Dravet Syndrome, Epilepsy, Familial Amyloid Polyneuropathy, Headaches, Migraines, Multiple Sclerosis, Neuro-Ophthalmology, Parkinson’s Disease, Peripheral Vascular Disease, Stroke, Sleep Disorders, Spasticity, Traumatic Brain Injury, Neuromuscular Disorders, Deep Brain Stimulation (DBS), Electromyography, Neuropsychology, Neuroradiology, Occupational Therapy, Pediatric Neurology, Physical Therapy, Pain Management, Cannabis Medical Treatment, and Nutrition & Wellness.