© 2015 Child Neurology Consulting, LLC (504) 507-0774
THE CHILD NEUROLOGY EXPERT
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PARENT CONFERENCE FORM
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Name of Parent or Legal Guardian
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Child's Gender and Age
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Phone Number #1
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Attorney's Name
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Attorney's Email
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Phone Number #1
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What would you like to discuss with Dr. Nelson (please be specific):
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Preferred time of conference call:
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Please carefully review Dr. Nelson's
fee schedule
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