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Patient Forms


These forms cannot be filled in or submitted online. You must download them, fill them out, and bring them with you to your appointment.

Your first appointment is an evaluation appointment. Until we see you and evaluate your needs, we will not be able to assess whether we can treat you as a patient at Pain Solutions.

Prior to your first visit, we ask that you download the registration forms listed below and bring them with you to your appointment. At that time you must also bring your insurance cards so that we may copy them for our files. Please note that any copayment or coinsurance will be due at the time of service.

Before our providers can accurately diagnose and treat your pain, we must have all of your relevant records over the last 3 years. Relevant records are those records that refer to your symptoms.


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Such records include the following: all MRI, CT scans, and X-ray reports, (we need the reports, the actual images are not necessary), all documentation of medical encounters concerning your symptoms, as well as a list of all medications, vitamins or other supplements you are taking.

We ask you to obtain these records and have them in our office forty-eight (48) hours prior to your scheduled appointment. If we do not receive the records in time for our providers to review them, we will call you to reschedule your appointment.


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Please Review & Fill Out These Forms:

There are SIX (6) forms. All must be completed before your first appointment. YOU CANNOT FILL THESE FORMS OUT ONLINE. Please download them, fill them out, and either mail them or bring them with you to your appointment.

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