New Patient Forms
Are you interested in becoming a new patient of the Center for Pain Management? Please read through the information on this page and then call us at 317.706.7246 to speak with a New Patient Coordinator.
NEW PATIENT FORMS
Fill out and bring these important forms with you to your first appointment. If the forms are missing or incomplete at the time of your appointment, you may have to wait or reschedule:
New Patient Packet
New Patient Health History
NEW PATIENT INTAKE PROCESS
Please read and follow our new patient intake process so you know what to expect and are prepared for your first appointment:
- Complete the NEW PATIENT PACKET. It is essential that you bring this completed packet to your appointment.
- A representative of our practice will call you to take your NEW PATIENT HEALTH HISTORY 2 to 3 days prior to your appointment. Please expect that call to take about 20 minutes. The questions that the representative will ask are included in the NEW PATIENT HEALTH HISTORY form if you want to review them in advance. This will shorten the time needed for the phone call. At a minimum please have available: a list of your allergies, list of all hospitalizations, surgeries, pain injections, and imaging tests with the facility name and the year; ALL medication bottles, and the exact date you last worked if you are not currently working.
- Our representative will call you. If it is more convenient, you may call at a good time for you between 8:00 and 4:30 Tue – Fri and ask to speak with our New Patient Coordinator at least 48 hours prior to your appointment.
- If we do not reach you before your appointment to discuss the questions included in the NEW PATIENT HEALTH HISTORY packet, please expect an extended wait to see that physician when you arrive.
Some other information that may be of interest to you:
- Insurance Coverage: We provide coverage for a variety of commercial insurance plans and HMOs. However, you are ultimately responsible for understanding and following your insurance program and its requirements. Please contact your insurance provider prior to your appointment to discuss your coverage.
- Medical Records: We must receive certain medical records before we can see you as a patient.
We look forward to helping you with your pain management needs.