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| Medical
Forms |
If
your insurance changed during the treatment cycle, please
fill out this form to alert us of changes and help to ensure
prompt payment.
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FORM |
FORMAT |
FORMAT |
| Patient
Intake |
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| Medical
Records Request
This
form authorizes The Pain Institute to obtain medical
records pertaining to evaluation and treatment. |
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| Medical
Records Release
This
form authorizes your doctor to obtain your information
from the Pain Institute
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| *PDF files
should be mailed to the following address: |
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