Thank you for your interest in Riverside Pain Physicians. It is the goal of our staff to provide you with the highest quality of service. For your convenience the following forms are available for you to print and bring with you to your new patient evaluation visit. Please review and complete. By doing this, you will allow the doctor to spend more time with you to evaluate and discuss your condition. If you are unable to print these forms from your computer, call the office at 904.389.1010 and request that the forms be mailed to your address.
In order to help us best take care of you, please bring the following to your first visit:
- Health Insurance Card/Information
- Photo Identification (drivers license or passport) .
- A copy of your MRI, X-rays or CT scan reports .
- List of of current medications
If you are being referred by a physician please make sure that we have received records and diagnostic testing. If you are a self referring patient please make sure you bring your records and diagnostic results with you to your consultation. Please note: you may not be seen if these items are not brought to your initial visit.
FOR AUTO ACCIDENT PATIENTS ONLY
- “Personal Injury Protection Insurance Disclosure Form”
- Universal Acknowledgement of NoticesPatient’s Bill of Rights & Responsibilities
- Ownership notice to patients & Notice of Policy Regarding Advanced Directives
Our goal is to provide you with courteous and timely service.
This requires all patients to make an effort to arrive on time and to let us know when appointments cannot be kept.
We look forward to meeting you soon,