Be Seen Today, Feel Better Tomorrow!

New Patient Forms

​new_patient_information_form_2018.pdfIf you are a new patient, we encourage you to complete your New Patient paperwork ahead of time.  Please complete the online forms and submit them electronically or print out hard copies of the forms and complete them prior to your appointment time.  We recommend using Google Chrome when submitting our electronic forms.
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We ask that all NEW PATIENTS bring recent imaging reports (MRI, CT, X-Ray, EMG). 
Also, please bring ALL CURRENT MEDICATIONS within their ORIGINAL PILL BOTTLES. 

To complete the New Patient Information Form and the New Patient Demographic Form online, please click the links below:
If you were involved in a Motor Vehicle Accident, please download, print and fill out the below form and bring it with you to your first appointment:

​Current Patient Form

​If you are a returning patient, we encourage you to complete your Returning Patient Information forms ahead of your next appointment. Please do not fill out these forms more than 24 hours prior to your appointment.

To complete the Returning Patient Information Form, download a hard copy to bring with you to your next appointment:

​Policy Form

​New and existing patients should download the Visit And Billing Policy Form to learn more about our visit and billing policies. This form contains important information regarding missed and rescheduled visits.

Insurance

We are in-network with most insurance companies.  We are NOT in-network with Blue Value or Blue Local.  

Release of Medical Information Form

​If you are a new or existing patient and would like to have your medical records sent to Atlantic Spine & Pain or sent from Atlantic Spine & Pain, please download, print, complete and fax the below form 919-573-9594:

​Pain Management Procedure Information

​If you are a new patient who is preparing to have a pain management procedure performed, please read the following F.A.Q. information related to pre and post procedure preparation.Procedure Consent Form

Opioid Contracts and Consents

Referring Physician Form

Thank you for your interest in referring a patient.  Your patient may have learned about the specialized services offered at Atlantic Spine & Pain and expressed interest in being referred to our clinic for a new patient evaluation. We believe that it is essential to obtain a comprehensive understanding of patients' previous treatments, medication management, applicable radiological studies performed, and any other relevant information that may be of importance, by obtaining treatment records and clinic notes from existing physicians.  We ask for you to Fax (919-573-9594) or mail us any medical records prior to their scheduling an appointment.  ​Thank you and we look forward to working with you.