New Patient Form

For new patients, fill out the form below.

Even though we are committed to compassionate care, we must exercise proper due diligence when prescribing opioid analgesics for chronic pain in order to follow state and federal guidelines. Therefore, our clinic policy is that an appropriate workup must be completed prior to the dispensing of any controlled prescription. This workup will include review of previous pharmacy/clinic records, evaluation by diagnostic and laboratory tests, and acceptable completion of a urine drug screen yielding expected results. Our clinic policy is to never co-prescribe benzodiazepines and opiate pain medications.

  • Please bring your driver’s license and insurance cards along with your completed new patient paperwork to your scheduled appointment. Payment for services is expected at the time of service (co- pays, co-insurance, private pay). We accept check, money order and
    credit cards (Visa, American Express, MasterCard, and Discover).
  • If you have been instructed to obtain imaging reports and/or films by our staff, please bring them to your appointment. Our office requires these as part of your consultation. If we do not have your films at the time of your appointment, you may be rescheduled.
  • Your initial visit at the Practice is a consultation. If a doctor referred you for an injection, you must be seen for an office visit first. Procedures are scheduled after the initial consultation.
  • If English is your second language, please make arrangements for someone to accompany you to your visit who can translate in order to provide you with the best healthcare service. We want you to fully understand your diagnosis and prognosis and have any questions you may have answered.