Patient Information - Inova Comprehensive Pain Centers

For your first appointment, please bring:

• A completed personal history form
• Any results of relevant diagnostic studies (MRI, CT scans, bone scans, EMG reports) or physical therapy and rehabilitation discharge paperwork, if applicable
• A list of your current medications and allergies to medications
• A list of all medications that you have used to treat your pain and whether they were effective
• A list of all other treatments you have received to help with your pain including injections, surgery, physical therapy, chiropractic or other treatments
• Your driver's license, insurance card and copayment
• Any medical records that have not already been faxed

This will vary depending on your condition. Some patients are sent for a specific procedure from their referring physician and may not need an extensive evaluation. Depending on your insurance, you may need an evaluation by one of the pain management providers prior to having a procedure – even if your referring doctor has recommended a specific procedure. For those patients with more complicated pain issues, the initial evaluation will take longer.

Please try to arrive 20 minutes early for your first pain management appointment and allow additional time to park and access our building and clinic suite.

Please check with your provider to see which forms may be required for your visit.

• Acknowledgement of Community Group Rules
• Acknowledgement of Patient Rights
• Authorization for Claims Payment and Review
• Care Coordination
• Human Rights (English & Spanish)
• Informed Consent Form
• Notice of Privacy Practices (available in 8 languages)
• Release of Information - Medical Records Request (available in 6 languages)