For your convenience the following forms are available for you to print and bring with you to your appointment.

  • Registration Form (sign and date)
  • Completed Patient Information Sheet (be as specific as possible)

Please sign in and provide our Medical Manager with the following items.

  • Health Insurance Cards
  • Photo identification
  • Request from your referring physician
  • If you are self referring, the name and address of your primary care physician so that Georgetown Pain Management can coordinate care.
  • If your insurance company requires that you obtain a Maryland Uniform Referral from your primary care physician to see a specialist
  • X-Rays or MRI’s (if applicable), please bring the films and the radiologist report from the exam.
  • Insurance company co-pay. Please be prepared to make co-pay payment at the time of your appointment. We accept cash and credit cards.
  • Directions can be found on our locations page. If you are more than 15 minutes late or are not properly prepared with the above items for your appointment, Georgetown Pain Management reserves the right to reschedule your appointment.

Before your surgical procedure:

  • Do not eat or drink after ANYTHING after midnight or before your procedure.
  • Do not take fish oil or blood thinners
  • Arrange for transportation home from the surgical center -you WILL NOT be allowed to drive yourself home.
  • A Medical Manager may provide you with additional restrictions.

 

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