HOW TO BECOME A PATIENT
If you have a Primary care physician, Specialist or Chiropractic physician who has been taking care of you, please have them send a referral to our New Patient Coordinators. As soon as your referral is received and reviewed our New Patient Coordinator will contact you and keep you updated on your New Patient Appointment Status.
If you do not have a referring physician, please fill out all of the New Patient Forms, obtain all of your imaging study reports and any medical records relating to your ongoing pain disorder. This packet can be emailed, mailed or hand delivered to our Institute for complete review by one of our physicians. Our New Patient Coordinator will contact you when the packet is received and keep you updated on your New Patient Appointment Status.
At Gulf Coast Pain Institute we understand that pain can disrupt your life and will do everything we can to help.
New Patient Paperwork
- Welcome Letter
- New Patient Intake Form
- Lifetime Insurance Assignment and Authorization Form
- Appointment No Show Policy
- Long Term Controlled Substance Therapy for Chronic Pain Consent Form
- Health Insurance Portability
- Pain Disability Index
- Patient History Index