About
- Our Providers
Pain Services
Testimonials
Info Center
Philanthropy
- Lance Fund
Contact Us

Make an Appointment

About
- Our Providers
Pain Services
Testimonials
Info Center
Philanthropy
- Lance Fund
Contact Us

info@carolinaspaincenter.com Call Us: 704-500-2332

Make an Appointment

info@carolinaspaincenter.com Call Us: 704-500-2332

New Patient Agreements

Home / Patient Forms / New Patient Agreements

All patient form submissions are encrypted via SSL technology. Your information is secure.

Required New Patient Forms

New Patient Intake Form
New Patient Agreements

Individual New Patient Forms

New Patient Intake Form
Consent to Operation/Procedure Form
Financial Agreement
Medical Records Release Form
Medication Use Agreement
Patient Authorization & Disclosure of Info
Notice of Privacy Practices

Returning Patient Forms

Follow-Up Intake Form
Medical Records Release Form
Anti-Coagulant Form
Post Procedure Discharge Form

About Carolinas Pain Center

At CPC, we encourage our patients to be in charge of their healthcare. Success in good health comes from a thriving partnership between patients and our doctors and staff. We encourage patients to be knowledgeable about their health and be responsible about the decisions involved in their health care.

Request Appointment Make a Payment

Search Form

Recent Articles

Superfood: Quinoa Tabouleh
Got Pain? Why You Should Try Acupuncture

Communicate

Request an Appointment
Refer a Patient
General Contact Info

© 2019 Carolinas Pain Center. All Rights Reserved. Website by Vale Studios.