New Patients
If you are an existing patient, click here
If you are new to our practice, please fill out the following New Patient Registration Forms for the provider that you will be seeing:
Dr. Fechtel, Dr. Pawar, Dr. Sales, Dr. Shah, A. McLouth, S. Hawrylkiw - General Neurology | Submit Electronically | Download/Print |
C. O'Neill, Y. Eckrich - Neurobehavioral | Submit Electronically | Download/Print |
Dr. Mahant - Movement Disorder | Submit Electronically | Download/Print |
Dr. Peche - Pediatric Neurology | Submit Electronically | Download/Print |
Dr. Ospina - Movement Disorder | Submit Electronically | Download/Print |
Dr. Ibarra, L. Nelson - Headache/Migraines | Submit Electronically | Download/Print |
Dr. Eross, K. Petcher, A. Valenzuela- Headache/Migraine | Submit Electronically | Download/Print |
Dr. McCoy, M. Scaramella - Headache/Migraine | Submit Electronically | Download/Print |
What to Bring to An Appointment
- Patient’s insurance card
- Physician referral forms, if required by insurance
- List of prescriptions and/or over-the-counter medications, including dose and frequency
- Information about the patient’s medical and surgical history
- Recent x-rays or relevant records
Know Where You Are Going
Foothills Neurology has several offices throughout the Valley. Make sure you are going to the correct office. Below is a list of our 6 locations with the providers available and procedures performed at each office.
Foothills Neurology - Main Office | Foothills Neurology - Testing Center | Foothills Neurobehavioral Health |
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4530 E. Muirwood Dr. #111 Phoenix, AZ 85048 | 4530 E. Muirwood Dr. #114 Phoenix, AZ 85048 | 15715 S 46th St. #100 Phoenix, AZ 85048 |
General Neurology New Patients, Follow Ups, Consults, Physical Therapy | EEG, EMG, NCS, VEP, OCT, HFA, Infusions, Headache/Migraine Patients | Psychiatry Patients, TMS, Neurocognitive Testing |
Dr. Fechtel, Dr. Mahant, Dr. Pawar, Dr. Sales, Dr. Shah, A. McLouth, C. Simons, M. Diedrich, S. Hawrylkiw, K. Lorincy, K. Hartman, A. Canizales, J. Satiroff | Dr. Ibarra, Dr. Visser, L. Nelson | C. O'Neill, M. Preston, R. Ibarra, Y. Eckrich, J. Grady, Nneka Aguwamba |
Phoenix Headache Insitute - PHI | Foothills Neurology - Midtown | Hope Pediatric Neurology |
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8415 N Pima Rd. #175 Scottsdale, AZ 85252 | 4001 N. 3rd St. #290 Phoenix, AZ 85012 Office on 2nd Level. Use Parking Garage. | 5422 W. Thunderbird Rd St. 13 Phoenix, AZ 85306 |
Headache/Migraine Patients, Infusions | Headache/Migraine Patients, Infusions | Pediatric Neurology, Childrens EEG |
Dr. Eross, K. Petcher, A. Valenzuela | Dr. Ospina, H. McCoy, M. Scaramela | Dr. Peche |
Existing Patients
If you are a new patient, click here
Symptoms / Conditions Downloads
General Neurology - New Problem | Submit Electronically | Download/Print |
Dr. Bowen New Problem | Download/Print | |
Headache Diary | Download/Print | |
Controlled-Substance | Download/Print | |
Botox | Download/Print | |
PENS | Download/Print | |
Balancing Body Chemistry Health Assessment | Download/Print | |
Naturopathic | Download/Print |
Privacy and Release Downloads
Medical Records Request | Submit Electronically | Download/Print |
Medical Records Fee | Download/Print | |
HIPPA Privacy Notice | Download/Print |
Headache Forms Downloads
Blank Trigger Tracker-PHI | Download/Print |
Trigger Tracker-PHI | Download/Print |
Headache Tracker-PHI | Download/Print |
Headache Impairment Questionaire-PHI | Download/Print |
Headache Impairment Tracker-PHI | Download/Print |
Diagnostic Exam Preperations
Routine EEG Instructions | Download/Print | |
Ambulatory EEG Instructions | Download/Print |