Patient Forms


Welcome Letter and Questionnaire
Prior to your first visit, please click here to read the attached welcome letter and complete the patient questionnaire, which contain important information you will need to know and provide to us. We do require your completed patient questionnaire before your scheduled appointment. It may be mailed to our office; faxed to our office at 330-337-6947; or brought in to our office during our normal hours of operation. If we do not receive this information prior to your appointment, we will call to cancel or reschedule your appointment.

EEG
This information is for patients who will be undergoing an EEG recording, ordered by Dr. Yan or another physician, to be performed in our office. Please click here and read the attached instructions prior to your test date as preparation for the procedure.

EMG/NCS
This information is for patients who will be undergoing EMG/NCS testing, ordered by Dr. Yan or another physician, to be performed in our office. Please click here and read the attached instructions prior to your test date as preparation for the procedure.

Evoked Potentials
This information is for patients who will be undergoing evoked potential testing, ordered by Dr. Yan or another physician, to be performed in our office. Please click here and read the attached instructions prior to your test date as preparation for the procedure.

Record Release
If your records from another physician need to be sent to Dr. Yan, or if your records from Dr. Yan need sent to another physician, please click here and fill out the attached record release form. It may be mailed to our office; faxed to our office at 330-337-6947; or brought in to our office during our normal hours of operation. Once we receive the form, we will forward the information as directed.

Note: The above documents require Adobe Reader to view. If you don't have this, please click here.