Office Info & Forms

Patient Forms

We are one of the first pain management offices in San Antonio to use an entirely paperless medical record, or electronic medical record. To aid in making your first visit more time efficient, we provide our initial in-take forms for your convenience. Please download these forms, fill them out fully and bring them with you at the time of your appointment. It is also important for you to be complete with your medical history particularly as it applies to pain condition. Check your insurance plan with the Premier Pain Consultant, P.A. insurance page to verify coverage.

Please bring the following to your scheduled appointment:

• All related medical records, reports, and original diagnostic films (X-rays, MRI, etc.)
• A valid insurance card and driver's license. If your picture ID does not reflect your current address, we will need a recent utility bill with current address.
• Bring all medication in original containers at each visit.
• Names, addresses and phone numbers of referring and primary doctors.
• Bring COMPLETED patient information forms.

To download forms, click a link below.

• Commercial Insurance New Patient Forms (Patient History, Payment Authorization, Controlled Substance Agreements, Office Protocol, Privacy Notice)
• Workman's Comp New Patient Forms (Patient History, Payment Authorization, Controlled Substance Agreements, Office Protocol, Privacy Notice)
• Pre-pain procedure medication recommendations.
• Post-procedure Instructions