SPINE AND PAIN

Physicians are the foundation of any outstanding medical practice, and the doctors at Spine & Pain Centers are among the very best in New York and New Jersey.
Learn More About Our Physicians:
Dr. Anil Sharma	Dr. Harris Bram
Dr. Charles Daknis	Dr. Sanjay Bakshi

MEDICAL AND OFFICE FORMS

For your convenience, Spine & Pain Medicine is providing you with the opportunity to download our medical and office

forms. Simply download, print and fill-out the appropiate forms and bring them with you to your appointment. Doing so will save you valuable time proir to your appointment.


Discharge Instructions for Spinal Injections	HIPPA Notice of Privacy	Patient Disclosure of Health Care Information	Home Care After Your Procedure

Instructions for In-Office Procedures	Informed Consent For Procedure	Consents: Office Procedure Room	In-Office Procedure Instructions

Initial Patient Intake	Post Procedure Pain Diary	Patient Demographics Form	Patient Forms: Insurance Company, Referring Doctor, Primary Doctor

Surgical Center Procedure Instructions	Insurance Authorization Responsibility	Payment Authorization Form	HIPPA Records Release

Request for Restriction of Protected Health Information	Surgical Center Notice