Spend Time With Our Pain Doctor; Complete Forms Online
We’ve made the most common patient forms available online so that you can save time at your visit, making chronic pain relief a main focus in the office, by completing them in the comfort of your home. Simply download the form(s), print, fill in, and bring them along to your appointment. If you’re not sure which forms you need, please don’t hesitate to call 844-200-PAIN (7246).
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1) New Patient Health History Form – Required
This outlines the history and current state of your health. We also encourage you to write down any questions that you have for our pain doctor so that we can be sure to cover them during your appointment.
2) Patient Health Information Consent (HIPAA) – Required
This form is required by the federal government to protect your confidential health information. If you would like your spouse, parent, or other important person to have access to information about your health, your appointments, billing, or any other aspect of your care, you’ll need to include them on this form. If you have any questions about this, or any other form, we will be happy to answer them at your appointment.
3) Patient Request for Records – As needed
Use this form when requesting to have your medical records sent to our office from another medical facility.
4) Re-Evaluation / Re-Exam Form – As needed
Upon completion of the initial phase of your care, the doctor may ask you to complete this form to assess the current status of your condition.