New Patient Forms
If 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.
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:
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:
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:
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. For more details on appointments, please see our No Show/Late Cancellation Policy.
Insurance and Financial Information
We are in-network with most insurance companies. We also accept workers' comp and motor vehicle accident/personal injury cases. We are NOT in-network with Blue Value, Blue Local, Blue Select, or Humana.
We accept cash, credit, and CareCredit as payment. We do not accept personal checks. For more information about CareCredit, or to apply for financing, click below.
We accept cash, credit, and CareCredit as payment. We do not accept personal checks. For more information about CareCredit, or to apply for financing, click below.
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.
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.
