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First Visit
Medical Records
Other Forms
Referral Process
First Visit
During your first or "initial consult" you will be asked to fill out a questionaire along
with various forms required by us and your insurance company. We will also ask for a
drivers license or other picture ID, insurance card and authorization/referral if required.
You should bring any medications, MRI scans or other reports that may relate to your condition.
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Medical Records
Your records can be obtained from our office or released from our office after you sign a release form.
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Other Forms
We will fill out standard forms relating to work comp injuries and other insurance forms.
We do not fill out disability parking permits or other disability related forms.
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Referral Process
A written referral from a staff physician is required in order for a patient to be
evaluated at Pain Consultants of Florida (this is in addition to the refferal that a
medical insurance carrier may require). You may use the one of Pain Consultants of
Florida Referral Forms by downloading from here
or by simply writing a letter. The following information must always be included in the
referral:
- Date of referral
- Patient's complete name, address, and daytime telepone number
- Patient's medical insurance information
- Referring physician's complete name, address and telephone number
- Reason for Referral
- History, diagnosis and laboratory/Radiologic data pertinent to presenting condition
This referral should be mailed to:
Pain Consultants of Florida, P.A.
3990 Sheridan Street, Suite 103
Hollywood, FL 33021
or faxed to: 1.954.986.0091
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