DOWNLOAD FORMS - IPM - Interventional Pain Medicine

Interventional Pain Medicine
196-17 Hillside Avenue
Hollis, NY 11423
Phone : (718) 479-3900

DOWNLOAD FORMS

Patient Information form
Privacy Policy
HIPPA Acknowledgement form
Pain Assessment form
Health Questionnare
Pre-Procedure General Instructions
Pre-Procedure Medication Instructions
Opioid Consent
Narcotics Contract
Post-Procedure Instructions
Post IV sedation Instructions
Post Injection Evaluation

* Please print them, fill them out, and bring them with you on your visit.

* The topics presented here are for informational purposes only. They are not intended to be a substitute for medical advice and information provided by your health care provider. Any decision you make regarding your health care optionsshould be made after consulting a qualified physician.