Patient Information

Hospital Affiliations

Dr. Burnham is affiliated with Swedish Medical Center in Englewood, CO.

Your First Appointment

Please arrive early so that we can complete your initial paperwork. 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

Patient Forms

For your convenience, please print and complete the following patient forms before your first visit to our office:

• Patient Registration Form
• Patient Health History (6 pages)
• Medical Records Release

Insurance and Payment Information

Jane A. Burnham, M.D., Ph.D. is a provider for Medicare and most major insurance plans, and provides insurance billing. 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.

EEG Instructions

1. No more than three to four hours of sleep the night before the test.

2. You must have clean hair for the test. Wash your hair but do not use any conditioner, spray, gel or other dressing on your hair.

3. Eat a good breakfast before you come in. Do not have any caffeine, starting the evening prior to the test, this includes coffee, tea, cola and chocolate.

4. The test will take approximately one hour.

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.

Jane A. Burnham, M.D., Ph.D.
701 E. Hampden Avenue
Suite 320
Englewood, CO 80113
Tel: 303.788.7440
Fax: 303.788.4633
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