UPG Department of Neurological Surgery   
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Before you visit us, you can save time by filling out our patient information packet and sending it to us online.
 Download UPG Neurosurgery PIP
You may need Adobe software; it can be found free here:
To download and complete the patient information packet, please follow these instructions:
  1. Click on "Download Patient Information Packet," found above.
  2. Click "Save">>Specify the file name>>Click "Save."
  3. Open the saved patient information packet.
  4. Fill in the fields found in the patient information packet, and then save your responses by clicking on "File," then "Save."
To assure that we will be able to assist you as fully as possible, please make sure to upload and send your completed and saved patient information packet to us using the submission fields below. Once this has been completed, one of our staff members will contact you to make / confirm your appointment with our physicians.

If you have any questions as to how to complete and send the patient information packet, please contact Brandon Parker at bjparker@med.wayne.edu

In addition to submitting this form, the following MUST be brought on the day of your appointment:
  • Any actual films (MRI, CT scan, myelogram, arteriogram, or routine X-ray) you possess.
  • Any applicable referral forms.
  • Your medical insurance forms.
The submission fields below allow you to send you patient information packet to our clinic staff in a safe and secure method.


Please complete the fields below:
First Name:*
Last Name:*
Phone:* (xxx-xxx-xxxx)
Upload Patient Information Packet:*
(Click the Browse button to browse for filled Patient Information Packet. Select Patient Information Packet and click open.)

(Please enter above code)
    *
 

 
Note: UPG Department of Neurosurgery takes your privacy seriously; we will never sell, rent, or give your personal information to anyone.