PainCare - Pain Management in New Hampshire

To expedite your first visit, please click on the links below to print patient intake forms. Fill them out as completely as you can and bring to your first appointment.

• Patient Registration: The patient registration form provides PainCare with your basic contact and insurance information.

• Patient History: The patient history form gives your PainCare provider a detailed summary of your medical history and your pain. (If you are unsure about completing parts of this form, leave them blank and a medical assistant will review the form with you at your initial visit.)

• New Patient Survey: All new patients must fill out this brief survey, which only takes a couple minutes of your time.  Your responses will help us in providing better patient services.

Attachments:

Informed Consent and Agreement for Treatment	[ ]	11/22/2011
Patient History	[A detailed summary of your medical and pain treatment histories]	11/22/2011
Patient Registration & Consent for Billing	[Basic contact and insurance information]	11/22/2011
New Patient Survey	[We ask that all new patients fill out this 2-minute survey]	12/20/2011