Current Patient Forms

If you are a current patient of the Center for Pain Management, please fill out the forms on this page. We occasionally update these forms and may ask you to complete the newest version. If you have any questions, please call us at 317.706.7246.


Adobe-PDF-icon  Opioid Agreement: If pain medication is prescribed as part of your treatment plan, you will be expected to safeguard your medication and comply with the other requirements of your Opioid Agreement.  In addition, failure to participate in the non-medication components of your treatment plan can result in discharge from the practice. Opioid medications are not appropriate for all patients. For that reason there is no guarantee that a patient will receive a prescription(s) for pain medication(s) on their first visit.

Adobe-PDF-icon  Center for Special Surgery Disclosure Packet: If you will be having an upcoming interventional procedure or outpatient surgery performed at the Center for Pain Management, please download and print the Center for Special Surgery Disclosure Packet and bring it with you on the day of your procedure/surgery.


Ready for Relief?
Fill out this form & we'll contact you to schedule an appointment.