Patient Forms

Hospital Affiliations

Dr. Maria A Herrera is affiliated with Memorial Hospital West in Pembroke Pines, FL

Your First Appointment

please arrive early so that we can complete your paperwork. To save time during your initial visit, please print out and complete these forms:


Also, please bring the following:

  • Patient’s insurance card
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient’s medical and surgical history
  • Recent test results, x-rays, or relevant records

Insurance and Payment Information

Pines NeuroCare is a provider for Medicare and most major insurance plans. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients and a copy is available upon request.