For New Patients

Thank you for choosing the Chase Family Movement Disorders Center and Hartford HealthCare Ayer Neuroscience Institute as your care provider.

We hope to make your first visit with us as stress-free as possible. Providing information prior to your appointment will help us as we evaluate you and develop a care plan.

Please have your physician or provider fax, e-scribe, or mail a clinical referral. Please keep in mind that this is different from an insurance referral. Once received, our office will contact you to schedule the appointment.

What to Bring

  • Remember to bring your insurance card and photo ID to your visit.
  • If your referring physician or provider is outside of Hartford HealthCare, please have any information relevant to your diagnosis mailed or faxed to us.
  • If you have had any imaging completed, please bring in the actual films on a CD.
  • If you are currently taking any medications or supplements, please bring in the current list with names, dosage amount, and dosage regimen.
  • It is preferred that you come with a caregiver or care partner to your appointments.

New Patient Forms

Once your appointment is scheduled, you can submit your patient information/questionnaire using the online using the links below:

If you prefer, you can download and fill out the forms below - please bring the completed forms with you to your appointment.

Chase Family Movement Disorders Center

  • Contact Us

    Phone: 860.870.6385
    Fax: 860.870.0625

  • Clínica Hispana del Centro de Trastornos del Movimiento Chase Famil

    Teléfono: 860.870.6385 
    Fax: 860.870.0625

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