Please be sure to bring the following completed forms to your first appointment:

Patient Registration Forms

Patient Health History

Treatment Agreements

Prior to your initial consultation at Granite State Pain Associates:

Our “New Patient Coordinator” will begin to collect information regarding your medical history. Granite State Pain Associates must generally receive medical records from your referring health care provider (if your insurance requires you to have one), along with demographic information.

Please help us gather the following types of information relevant to your pain issue. Our “New Patient Coordinator” will review exactly what you need to bring:

• Insurance Card and Photo ID
• List of medications you are currently taking or have taken in the past year
• X-Ray reports (disc copies preferred)
• MRI reports (disc copies preferred)
• CT reports (disc copies preferred)
• EMG reports
• Lab results
• Anything not listed you feel is important for your consultation
• Any previous pain clinic records

Your Initial Consultation:

Check in:

Please plan to arrive 30 minutes prior to your scheduled appointment if your paperwork is filled out, or 1 hour prior to your appointment if your paperwork is not filled out. When you arrive, check in with our receptionist. A member of the New Patient Referral Team will then sit down with you and take your photo for our confidential electronic records. They will then assist you in completing the following:

• Registration information
• Medication agreement
• Medical records release

If you would like to further expedite your check-in experience, you can print and complete the registration and patient health history forms (listed at the top of this page) prior to your appointment.

Once complete, you will be escorted into an examination room where a medical assistant will begin the appointment process.

This initial consultation allows for a more detailed investigation into your pain problem, including:

• An extensive review of your pain history and prior treatments
• A focused physical exam
• A discussion of the treatment plan
• Addressing any of your questions or concerns

The treatment plan developed from this initial meeting will be used to guide your future course. It is possible that no formal treatment may be started on your first visit. This decision is made on a number of factors, such as:

• A need for a specific injection that must generally be scheduled for another day
• Availability of adequate past records
• Possibility of illicit drug use
• The need for a urine, blood or further radiologic tests prior to starting new therapy

You may review our Notice Of Privacy Practices , which explains how we use your health information. Thank you for choosing Granite State Pain Associates.