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New Patient Information


 

New Patient Information

BEFORE YOUR APPOINTMENT

New Patient Forms

Pain Management of North Dallas offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • You can fill forms directly on your phone or computer
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment or you may email them to info@ndallaspain.com

New Patient Registration Form (for INSURANCE Patients)
Click to Download

New Patient Registration Form (for ATTORNEY-PROTECTED Patients)
Click to Download

WHAT TO BRING WITH YOU TO YOUR FIRST APPOINTMENT

  • Completed Patient Forms
  • Photo ID
  • Current Insurance Card
  • All medication bottles you are currently taking
  • Any medical records that might be useful in your evaluation; labs, recent physical, IQ or psychological testing results, in addition for children also recent report card, behavior sheets.
  • Ensure your new patient paperwork has been completed–make sure you have read and signed all forms. (You can still complete the forms when you arrive 30 minutes prior to your appointment time)
  • Medications will NOT be prescribed on the first office visit.
  • Physician Reports: We require your most recent physician reports and ALL radiology reports (X-rays, MRIs, CTs etc) be sent to our office by your treating physician PRIOR to your appointment. If you are unable to gather those items then we will need to reschedule your appointment.

New patients are required to arrive 30 minutes prior to your first scheduled appointment time to complete registration and check-in, in order to maximize your appointment time.


INSURANCE ACCEPTED

  • Aetna
  • Blue Cross Blue Shield
  • United Health Care
  • Cigna
  • Superior Ambetter
  • Tricare
  • Humana
  • Traditional Medicare
  • AARP
  • Medicare replacement plans

QUESTIONS?

If you have any questions, please call us at (214) 618-0853.

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