Established Patient Forms

Patients are asked to fill out a Pain Questionnaire at each visit. This gives your provider your most current pain information. We encourage you to print the form using the link below and bring it completed with you to your next appointment.

Your privacy is important to us. Therefore, we MUST have written consent before we will disclose any of your information. Such information may include, but is not limited to: appointment dates/times, billing information, and information concerning your medications. If it is likely someone may call on your behalf concerning any of these subjects and you would like us to be able to speak to him/her, please bring this completed form to your next appointment or mail it directly to the office. To complete the form: fill in your whole name and date of birth at the top of the page, list the full name(s) of anyone to whom we would be allowed to disclose information, circle the kind of information we will be allowed to disclose next to the person’s name, then sign and date the bottom of the page. For more information about your privacy and rights, see our Privacy Policy.

We, at Oklahoma Pain Center, ask you to renew certain patient paperwork yearly. Click the appropriate link below to view this paperwork. PLEASE DO NOT FILL OUT ANY OF THE FORMS. Our office will let you know when it is time to renew these contracts/forms.

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