New Patient Forms
If you would like to request an appointment with our surgeons in the Center for Nerve Injury and Paralysis, the following medical records/forms need to be faxed to our office at (314) 367-0225:
- A letter of referral from your physician detailing the nature of your nerve condition or injury, including your symptoms and functional use of the affected extremity (-ities).
- Reports of any diagnostic studies including EMG/nerve conduction studies, MRI, CT scans, ultrasounds.
- Operative notes from previous surgeries to the affected extremity (-ities).
- Demographics (address, phone number, date of birth, etc.) and health insurance information
- Completion of the New Patient Forms including the General Health Questionnaire for Patients with a Nerve Injury/Condition, Pain Questionnaire, and SF-8 Health Survey.
Alternatively, materials may be mailed to:
Washington University School of Medicine
Division of Plastics & Reconstructive Surgery
ATTN: Aimee Roche, RN
660 S. Euclid Ave.
Campus Box 8238
St. Louis, MO 63110
Once all of the required records are received, they will be reviewed within 30 days of receipt. Aimee Roche, RN, our clinical nurse coordinator, will contact you.
General Health Questionnaire for Patients with a Nerve Injury/Condition
For more information on C6/7 spinal cord injury and to be considered as a new patient with this condition, go to this web page.