Get Jax Spine & Pain Centers New Patient Packet 2019-2025

Completing your new patient packet is an essential step in your journey towards effective pain management at Jax Spine & Pain Centers. This guide will walk you through each section of the form, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to complete your new patient packet online efficiently.

1. Click ‘Get Form’ button to acquire the Jax Spine & Pain Centers New Patient Packet and open it for editing.
2. Fill in your demographics, including your name, date of birth, and contact details in the designated fields. Ensure you also include your primary and secondary insurance information.
3. Indicate whether you were referred for this visit and provide the name of the referring individual, if applicable.
4. Detail the reason for your visit and any relevant pain history. Use the prompts to describe accidents, previous treatments, and severity of pain.
5. Complete the pain diagram by marking areas where you experience symptoms and provide a description of the pain characteristics.
6. List any past medical and surgical history, as well as allergies and current medications in the specified sections.
7. Disclose any social history-related questions, such as smoking and alcohol use. Provide information on your family history if requested.
8. Read and acknowledge the patient/doctor treatment and medication agreement, ensuring you understand the regulations and expectations.
9. Complete the assignment of insurance benefits and release of information. This involves authorizing Jax Spine & Pain Centers to handle your insurance claims.
10. Review the financial policy and confirm understanding by signing where indicated. If needed, consult with staff before signing.
11. Once all sections are filled out and reviewed, save your changes, and choose to download, print, or share the form as required.

Complete your new patient packet online today to streamline your visit to Jax Spine & Pain Centers.