ID & INSURANCE:

Please bring with you your insurance card and driver’s license. Deductibles and co-payments are due and will be collected at the time of your visit. You will be responsible for payment at the time of service if you arrive without your insurance card. Your insurance is a contract between you and your carrier. Our staff will assist you to the best of their ability in assisting with your insurance company, but it is your responsibility to know your insurance policy and coverage of your plan before you arrive for your visit. If you are choosing to use your point of service or Out of Network Options, we recommend that you contact your insurance carrier prior to coming to our office to notify them that you are using this option for our doctors.

Thank you for choosing Inland Pain Medicine.  Please fill out the downloable information packet and forms if you are a new patient.  In order to serve you in a timely manner, we ask that you complete the PRIOR to your appointment and bring this information with you at the time of your appointment.  Please do not mail these forms back to our office.  If your paperwork is incomplete or forgotten, please arrive 30- 45 minutes early to fill out paperwork or we may need to reschedule your appointment.

NEW PATIENT FORMS:

New Patient Packet

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