Patient Forms

If you have a new patient appointment with Dr. Jung or Dr. Robles at Northlake Neurology, please download and print these new patient
forms. Once completed, please fax them to 704-316-1848 or mail them to: Northlake Neurology, 16525 Holly Crest Lane, Suite 120,
Huntersville, NC 28078.

These forms will need to be faxed or mailed to our office PRIOR TO your appointment.

If your appointment is within the next 2 days, please complete the forms and bring them with you to your appointment, as that they will not
arrive on time if you mail them.

Consent to Treat
Financial Policy
Privacy Form
Medical Records Release Form