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Call Us Today!
(205) 536-8736
Call Us Today!
(205) 536-8736

Patient Forms

Dr. Counce is a board-certified Neurologist and Board Certified Neuroradiologist

Click on the Patient Portal link to:

  • Exchange messages with our practice
  • Review and pay billing statements
  • Request appointments
  • Research health topics
  • Review personal health information
  • Complete and update medical forms
  • Update your profile and contact information
New patients, please download and fill out the forms below before your initial visit.
File

Privacy Practices

Download File
File

Medical Record Release

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File

Test Patient Questionnaire

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File

Non-Headache Questionnaire

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File

Headache/Migraine Questionnaire

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Call Us Today At ♦ (205) 536-8736

YP Reviews

Address

Diane Counce, MD
1000 Southlake Park, Suite 200
Birmingham, AL 35244
Phone: (205) 536-8736
Fax: (205) 536-8737

Business Hours

Mon - Thu: 08:00 AM - 04:00 PM
Fri: 08:00 AM - 12:00 PM
Sat - Sun: Closed

Payment Options