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.)

Attachments:

File	Description
Patient Registration Form	(1 pg) - basic contact and insurance information
Patient History	(4 pgs) - a detailed summary of your medical history and your pain
New Patient Survey	revised 1/4/2010