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Patient Tools - Forms & Handouts
Discogram
Epidural Steroid Injection
Intraarticular Facet Injection
Medial Branch Block
Lumbar Sympathetic Nerve Block
Intercostal Nerve Block
Selective Nerve Root Block
Radiofrequency
Vertebroplasty
Spinal Cord Stimulator
Epidural Steroid Injection
Intraarticular Facet Injection
Medial Branch Block
Lumbar Sympathetic Nerve Block
Intercostal Nerve Block
Selective Nerve Root Block
Radiofrequency
Vertebroplasty
Spinal Cord Stimulator
New Patient Welcome Letter
Notice of Privacy Practices
Consent to Treat and Release Information
Patient Confidentiality
Authorization for Disclosure of Health Information
Informed Consent and Pain Management Agreement
Initial Patient Registration
Patient Initial Encounter Form
Patient Financial Responsibility Form
Notice of Privacy Practices
Consent to Treat and Release Information
Patient Confidentiality
Authorization for Disclosure of Health Information
Informed Consent and Pain Management Agreement
Initial Patient Registration
Patient Initial Encounter Form
Patient Financial Responsibility Form
Procedure Handouts:
Practice Guidelines & Patient Forms (please print & complete prior to your visit)
1207 Arista Dr. Suite 103
Rockwall, TX 75032
Phone: 214.771.3535
Fax: 214.276.1708
Rockwall, TX 75032
Phone: 214.771.3535
Fax: 214.276.1708
| C E N T R A L |
| P A I N M A N A G E M E N T, P. A. |