Helping People Avoid Spine Surgery
Our Goal is Simple: To help as many people as possible avoid spine surgery.

Patient Forms

ProMED Pain Rehabilitation Institute

No two pain issues are the same, just as no two patients are the same. ProMED Pain Rehabilitation Institute understands that you need personalized attention to treat your symptoms. When you trust us to offer you a solution, we do our best to create a plan that effectively manages your symptoms without the drugs, side effects, and other negative issues associated with traditional treatment options.

In order to help all of our patients before they come in for treatment, our specialist offers the following forms. Please print and fill these out to help us treat your pain effectively and efficiently.

  • Patient Information Form: This form provides us with your basic information, insurance information, and a medical release form that allows our doctor to treat your pain symptoms.
  • New Patient Form: If you are new to ProMED, this form is used to describe your pain symptoms, your medical history, any treatments you have already gone through, and more. This information will let our doctor treat your symptom and give us more information on how to help you.

Get Your Complimentary Consultation

  • Schedule a comprehensive evaluation with our doctor
  • An advanced option that works where others have failed
  • We tailor your treatment based on your health history
  • We’ll address your specific conditions & individual needs
  • Dedicated to helping people with their pain

We Accept Most Major Insurance & PPO

  • BlueShield
  • Aetna
  • Humana
  • United
  • CareCredit