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8010 Roswell Road Suite 140 Atlanta, GA 30350 Tel: (470) 7478989 Fax: (470) 2079027 www.cnsatlanta.comRELEASE OF MEDICAL RECORDS PATIENTS NAMEDOBADDRESSCHECK ONE : I HEREBY AUTHORIZE ___ (REFERRED
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Fill out all required personal information accurately, including name, date of birth, address, and contact information.
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Who needs crescent neurology and sleep?

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Individuals experiencing neurological issues such as headaches, seizures, or movement disorders.
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Individuals with sleep disorders such as insomnia, sleep apnea, or narcolepsy.
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People looking for a comprehensive evaluation and treatment plan for their neurological or sleep-related concerns.
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Crescent Neurology and Sleep is a medical facility specializing in neurology treatments and sleep disorders.
Patients seeking treatment at Crescent Neurology and Sleep are required to file medical history forms.
Patients can fill out the necessary forms either online or in-person at the medical facility.
The purpose of Crescent Neurology and Sleep is to provide medical care and treatment for neurological conditions and sleep disorders.
Patients must report their medical history, symptoms, current medications, and any relevant test results.
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