New Patient Information

New Patient Encounter Form (PDF)

New Patient Information (PDF)

Medication Protocol (PDF)

Welcome to the Michigan Brain and Spine Surgery Center.  We look forward to working with you.  The following is information designed to assist you in being prepared for your appointment and to assist the doctor in caring for you.

Please read through the information and call if you have any questions prior to your scheduled appointment with Dr. Zamorano.

Please bring the following with you:

1. Completed patient intake information
2. Actual x-ray, MRI or CT scan films and report
3. Written reports of any additional tests – EMG, ultrasound
4. Photo ID – either driver’s license, state ID or passport
5. Insurance cards and information
6. If required by your insurance – appointment referral form
7. Copay or deductible payment

COPAY AND DEDUCTIBLES:

Co-pay and deductibles are due at the time of your office visit.

WORKER’S COMPENSATION AND AUTO INSURANCE CLAIMS:

Please bring the following with you:

1. Name and address of adjuster
2. Claim number
3. Name and address of lawyer
4. Emergency room discharge paperwork

REFERRAL NEEDED FOR APPOINTMENT:

All HMO insurance claims require referral from the primary care physician prior to the appointment with the specialist.

Failure to bring the appropriate or completed information to your appointment may result in rescheduling your appointment to another day.

If you have any questions or are unable to make your appointment, please contact our office at 248-723-2477

Case manager appointments with Michigan Brain and Spine Surgery Center:

Recognizing the benefit to our patients when there is a case manager to expedite and/or arrange for testing and treatment, we are happy to meet with them as follows:

1. The patient agrees to have the case manager present at a regularly scheduled office visit.
2. We will only meet with the case manager when the patient is present.  We do not make separate appointments for the case manager.

INSURANCE AND DISABILITY FORMS:

You may need to have some insurance or disability forms completed while you are under the care of the Michigan Brain and Spine Surgery Center.  The following is our process for completing those forms:

• You can expect that the form will be completed and sent to the appropriate address within five business days after receiving completed forms and authorization.
• Note: we do not do functional capacity assessments.  That examination needs to be done by a physiatrist or a physical therapy practice.
• If you have a form that needs to be completed:

1. Please complete all portions of the form that are to be done by you before submitting it.
2. Be sure to sign and date the form where required.  If there is no place to sign on the form, you will need to complete an authorization form.

We are happy to send the completed form directly to the company, if you provide the address where it is to be sent.  Forms will be returned to you if your portion is not completed and proper authorization is not attached.

Medication Protocol – All prescriptions at the Michigan Brain and Spine Surgery Center are either electronically prescribed or dispensed at the discretion of the provider at your office visit.

You can download the documents in PDF format by clicking the links below:
(Adobe Reader is required to view the documents below)