LAKESIDE NEUROLOGY
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    • Dr. Frank Puhalovich
    • Dr. Peter Futrell
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Patient Forms


medical release formS

Please print and complete the REQUEST FOR MEDICAL RECORDS form if you would like to request your records from another physician to be sent to our office.  Please print and complete the PATIENT REQUEST FROM MEDICAL INFORMATION FROM LAKESIDE NEUROLOGY PC to have your records sent to another physician.
Please print and complete the Individual Request for Access to Records for a copy of your individual records.

medical_record_requests.pdf
File Size: 152 kb
File Type: pdf
Download File


Notice of Privacy Practices

HIPPA_Packet_LSN.pdf
File Size: 437 kb
File Type: pdf
Download File

Note: You do NOT have to print this packet. 

New Patient Forms 

newpatientforms.pdf
File Size: 5667 kb
File Type: pdf
Download File

Please print and complete this form if you are a new patient. Bring the completed forms to your first appointment.

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Lakeside Neurology
Phone: 770.203.4881
Fax: 470.839.2435
1100 Northside Forsyth Drive, Suite 440, Cumming, GA 30041
Copyright © 2018
  • Home
  • Our Providers
    • Dr. Frank Puhalovich
    • Dr. Peter Futrell
  • Patient Registration
    • Patient Registration PDF
    • Patient Portal
  • Contact Us/Office Hours