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Registration Forms

Please print and fill out these forms, and bring them to your appointment with Overlake Medical Clinics. Thank you.

Release of Information (ROI) Request

Neurology

Our neurologists, Dr. Daniel P. Fosmire and Dr. Olav Jaren have extensive experience in the diagnosis and treatment of neurological disorders and conditions. We are dedicated to offering quality service with the least-invasive and most promising solutions available.

Overlake Neurology is part of the Overlake Neuroscience Institute, which is dedicated to advancing the fields of neurology and neurosurgery, providing leading-edge, compassionate clinical care and conducting unparalleled research for the full range of neurological conditions.

Neurology is a medical specialty treating disorders of the nervous system. This includes diseases of the brain, spinal cord, nerves, and muscles. Our physicians' areas of special interest include:

  • Central and peripheral nervous system disorders
  • Evaluations with nerve condition studies and electromyography (EMG)
  • Cognitive disorders and dementia (problems with thinking and remembering)
  • Headaches
  • Movement disorders
  • Parkinson's disease
  • Seizures
  • Multiple sclerosis (MS)
  • Strokes

Services

Our diagnostic services include:

  • Nerve conduction services
  • Electromyography (EMG)

We see patients aged 16 and older, including

We may see a patient younger then 16 at the discretion of the physicians. Please contact our office if you wish to be treated by one of our physicians and you or your child is younger then 16 years of age.

Patient Information

What to Bring to Your Appointment

  • Your insurance card
  • Physician referral forms if required by insurance
  • A list of current prescription or over-the-counter medications you are taking, including dose and frequency
  • Pertinent information about your medical and surgical history (Patient Health History form)
  • Any recent x-rays or appropriate records you may have

Our Office Policy

Our physicians see patients on a referral basis only from another physician. Please contact your primary care provider to initiate a referral to our office. Please have them send your most recent chart notes, labs and any relevant imaging that may be pertinent to your appt. Our physicians require your notes be at our office prior to your appointment. Most insurances do not require a referral to be processed through them, however if you have an insurance that requires this, you are responsible to make sure this is in place prior to your visit to our office. If a referral is required and not processed prior to your appointment, you may be responsible for your visit.

Our office understands your time is valuable and will always make every effort to be respectful of that time. We kindly ask that you extend the same courtesy. If you are unable to keep a scheduled appointment, we ask that you give at least 24 hour notice, to give the opportunity for another patient to have that time. We understand emergent things come up, and are to hard to control. For this reason we offer an after hours answering service you can reach anytime, day or night. Just call our office number 425.709.7055 and you can be directly connected.

Glossary

Support

The following links are provided and monitored by Healthcommunities.com, the publisher of neurologychannel:

Healthcommunities.com, Inc., the publisher of neurologychannel, does not endorse specific organizations. Every effort has been made to ensure the accuracy of the following links, which are provided as a courtesy. If any information requires updating, please contact neurologychannel.

Hotlines National Child Abuse Hotline 1.800.422.4453(1-800-4-A-Child)

The National Domestic Violence Hotline 1.800.799.7233(1-800-799-SAFE)

Poison Control 1.800.222.1222

National Suicide Prevention Lifeline 1.800.273.8255(1-800-273-TALK)

Attention Deficit Disorder ADD Resources Children and Adults with ADD (CHADD)

ALS ALS Association

Alzheimer's Disease Alzheimer's Association Alzheimer's Disease Education and Referral (ADEAR Center) American Association for Geriatric Psychiatry American Health Assistance Foundation Consumer Consortium on Assisted Living Eldercare Locator Ethnic Elders Care

Aphasia National Aphasia Association

Ataxia National Ataxia Foundation (NFA)

Autism Autism Research Institute Growing Minds Autism Programs Interactive Autism Network The Son-Rise Program...The Autism Treatment Center Of America

Brain Injury Brain Injury Association Inc.

Cerebral Palsy BlazeSports® United Cerebral Palsy

Creutzfeldt-Jakob Disease (CJD) Creutzfeldt-Jakob Disease Foundation, Inc.

Dystonia Dystonia Medical Research Foundation (DMRF)

Epilepsy The Epilepsy Foundation

Fibromyalgia National Fibromyalgia Association

Guillain-Barre Syndrome Guillain-Barre Syndrome Foundation International

Headache/Migraine American Council for Headache Education (ACHE) National Headache Foundation World Headache Alliance

Hemifacial Spasm Hemifacial Spasm Association

Huntington's Disease Caring For People with Huntington's DiseaseHuntington's Disease Society of America

Lyme Disease American Lyme Disease FoundationLyme Disease: A Patients GuideLyme Disease Info

Multiple Sclerosis Multiple Sclerosis Association of America (MSAA)National Multiple Sclerosis Society

Movement Disorders WE MOVE

Muscular Dystrophy Muscular Dystrophy Association

Myasthenia Gravis Myasthenia Gravis Foundation of America (MGF)

Neurofibromatosis Neurofibromatosis, Inc.The Children's Tumor Foundation

Neuropathy Charcot-Marie-Tooth AssociationThe Neuropathy Association

Pain Management National Foundation for the Treatment of PainAmerican Chronic Pain Association, Inc. (ACPA)Spine Health

Parkinson's Disease American Parkinson Disease AssociationThe Michael J. Fox Foundation for Parkinson's ResearchNational Parkinson Foundation, Inc.Parkinson's Disease Foundation

Restless Leg Syndrome Restless Legs Syndrome Foundation

Spasmodic Dystonia/Torticollis National Spasmodic Dystonia Association (NSDA)National Spasmodic Torticollis Association (NSTA)

Stem Cell Information Stem Cell Information

Stroke American Stroke AssociationNational Institute of Neurological Disorders and StrokeNational Stroke Association

Tourette Syndrome Tourette Syndrome Association, Inc.

Tremor International Tremor FoundationTremor Action Network

Other Neurological Resources Aging Parents and Elder CareThe Brain MattersChristopher and Dana Reeve Paralysis Resource CenterFamily Caregiver AllianceThe National Rehabilitation Information Center (NARIC)

General Health Care Resources OTCsafety.org: Safe & Effective OTC Medicine Use Safe Medication