Thank you for taking the time to help us improve the way we serve our patients.

Your NeuroCare physician:
..choose below Dr. Bavis Dr. Berke Dr. Bhagat Dr. Burkholder Dr. Casanova Dr. Hagen Dr. Jaberi Dr. Kinast Dr. Nafziger Dr. Rosenberg Dr. Stalker Dr. Washington

The health concern that brought you to NeuroCare:
..choose below ADD (Attention Deficit Disorder) ALS (Lou Gehrig's Disease) Amputee Rehabilitation Autism (Pediatric) Alzheimer's Disease Back Pain Behavior Disorders (Pediatric) Carpal Tunnel Syndrome Cerebral Palsy (Adult and Pediatric) Chromosome Abnormality-Fragile X (Pediatric) Chronic Pain Epilepsy Headaches (Adult and Pediatric) Joint Pain Multiple Sclerosis Myasthenia Gravis Osteoarthritis Parkinson's Disease Radiculopathy Seizures (Pediatric) Sleep Apnea Stroke Stroke Rehabilitation Tendonitis Tourette Syndrome Other (specify below)
Other:

Did you have any special tests done at our office?
..choose below Carotid Ultrasounds EEG (Electroencephalography) EMG (Electromyography) ENG (Electronystagmography) Epidural Trigger Point Injections BAEP (Brainstem Auditory Evolked Potentials) BAEP for Infants DSEP (Dermatomal Somatosensory Evoked Potential) SEP (Somatosensory Evoked Potential) VEP (Visual Evoked Potential) MRI (Magnetic Resonance Imaging) Nerve Blocks TCD (Transcranial Doppler Sonography) TOVA (Attention Deficit Disorder Testing)

How long have you been a patient here?
..choose below First visit less than one year 1-3 years 3-5 years 5-10 years 10+ years

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