Preparing for Your Appointment

Please write down any questions or concerns that you may have, and bring this list with you to the appointment. That way, we can be sure to cover what is most important to you while you are here. You may also consider bringing someone with you – a spouse, significant other, confidant, or friend. While not a requirement, many clients find it helpful to have someone along to help you remember what you wanted to say, and can confirm for you later what was said at the appointment.

For new patients, please fill out all of the below forms prior to your appointment. If you have any questions, please contact our client liaisons for assistance, they will be happy to help you.

Click on the links below to view or download the PDFs for printing.

• Complete Patient Medical Forms
• Headache Description Form
• Headache Diary

• Please bring any available medical records that relate to your headaches, and that you feel would be helpful. Examples:
  Copies of test results: such as Labs/blood work, MRI, CT, X-ray, Sleep Studies, Echocardiograms, other imaging studies.
• Copies of pertinent procedure/surgery notes: such as injections, head & neck surgeries.

It is very important that we receive a current and accurate list of all your medications (including dose, frequency, prescribing doctor). Please also include separately, a list of all over-the-counter medications and supplements. Many clients find it helpful to bring the bottles.

Visits to The Ament Headache Center are covered by most insurance plans under the Out-of-Network benefits provision. AHC is a Direct Pay practice, which means that payment in full is expected at the time of service. As a courtesy, we will provide you with the form to send to your insurance company, and they will reimburse you directly, based on the specifics of your policy, according to their “out of network fee”.

To make a referral, print the Referral Form and fax it back to us at (303) 835-0730. You may also send us an email, or call us at (303) 834-5677

• Referral Form