Patient Information and Medical Forms
Preparing For Your First Appointment:
Call our office at (314) 991-7707 to schedule your appointment.
Be sure to check with your insurance company to determine if you will need a referral to see our one of our spine specialists. If so, please contact your primary care physician to obtain the necessary paperwork.
On your first visit, please bring with you:
Previous x-rays or other diagnostic test films. This includes myelogram with post myelogram CT scan, MRIs and CT scans. While radiology reports are helpful, they do not replace the actual films. If you are unable to get your films by your appointment date, you will need to reschedule. You will likely have better success getting your films if you personally pick them up versus relying on someone to transfer them to our office.

Insurance information.
You will need your current insurance card and referral, if required.
Co-payments are due at the time of your appointment. We accept MasterCard and Visa.

New patient forms.
The new patient and medical forms must be completely filled out and signed prior to your first visit, and brought with you on your appointment day. Having them ready when you arrive means you will see the doctor that much faster!

Worker’s Comp Patients Only:
Picture identification. Please bring a driver’s license or other picture I.D.
Appropriate signatures. The new patient forms must be signed. The doctor will not be able to see you if these are not signed (even if an attorney advised you not to sign them).

Rescheduling An Appointment:
In the event you must cancel an appointment, we ask that you do so 24 hours in advance. If you are a Worker’s Comp patient, you must notify your caseworker of this cancellation. Patient And Medical Forms:
Below are the patient and medical forms that will be needed on your first visit. You can complete these in two ways:

1) Download them to your computer, print and complete them by hand.
2) Complete them on your computer and print them.

Don’t forget to sign your forms! These forms are in Adobe Acrobat (PDF) format. If you do not have Adobe Acrobat on your computer, you will need to download it free from the Adobe website by clicking the image below.

Downloadable Forms:
New Patient Registration Form
Health History Form
Worker’s Compensation New Patient Registration Form

Please note: It may take a few minutes to load the forms if you are using a dial-up Internet Connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.