What to Bring to Your Appointment
If you are a new patient, please arrive 1 hour early to complete paperwork. However, if you have completed the form below, it is only necessary to arrive fifteen minutes before your scheduled appointment.
On the day of your appointment, we will also need the following information:
Your current insurance card
Current picture identification
- A list of your current medications
- Medical records (including disc of images)
- New Patient Forms
Payment Options
Segura Neuroscience & Pain Center accepts most insurance plans, but patients should always check with their individual carriers to determine our participation with their plans.
New Patient Form - Online
To complete your new patient form online, please click the button below. You will be directed to our secure, online form.
New Patient Online Form
New Patient Form - Download & Print
To download and print your new patient form, please click the button below. Please remember to bring your completed form with you to your appointment.
New Patient Download & Print
Existing Patient Forms
If you are an existing patient, please use the forms below to keep your records up to date or to authorize the release of protected health information.
View Existing Patient Forms
Existing Patient Text Number
If you are an existing patient with a non-emergency question or concern, please text the number below. This line is for non-emergency communication with existing patients only. If you are experiencing a medical emergency, please dial 911.
(877)758-6751
Questions? Ask our doctors
Schedule a Consultation