Patient Forms


Patient Forms

First Appointment Orientation

At Pain Management Specialists of New York, we recognize that you have many choices for medical care and appreciate that you are placing your trust in us. I’d like to personally thank you for choosing Pain Management Specialists of New York. Our mission to provide the very best care and attention available with the goal of alleviating pain, improving function and increasing your quality of life. We strive to utilize all pain management treatment modalities available as related to your specific diagnosis. We also understand that pain not only affects your body, but can also affect your spirit, family, friends and your overall quality and enjoyment of life. We offer comprehensive treatment while keeping in mind the most important person in the process is you. We will never pressure you into a particular treatment regimen. You are always in control and have a choice. We will discuss your plan of care and carefully explain the risks and benefits of all treatments along with treatment alternatives. We want you to be comfortable with your care, and hope you will choose us when pain impacts your life.

Downloadable Forms

Please download and fill out applicable paperwork prior to your first appointment with your pain doctor. First Registration form HIPPA Privacy Policy Follow-Up Form Pre-Surgery Form Anesthesia Instructions Some things to keep in mind:

  • You can download and print, review, or ask for a complete set of Privacy Policies for Pain Management Specialists of New York.
  • We will be happy to review and answer any questions about your paperwork or other matters.
  • Please bring your authorization number, if your insurance company gives one to you.
  • If required by your insurance coverage please don’t forget to bring your referral for treatment.
  • Please bring your insurance card, if you are using your insurance.
  • If your insurance provides it, enter your co-pay information (usually for specialist) on the paperwork above. If you have out-of-network coverage, you’ll pay for your doctor’s visit in full at each visit and submit a receipt that we give you to your insurance company. If you do not know your out-of-network information, please contact your insurance company and ask for an explanation of benefit coverage for pain management health issues.

Contact Us

If you have questions about your first appointment orientation, please call us at (718) 932-1740.

Our Locations

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