Pain Clinic | Patient Forms

Tampa Pain Clinic | Genesis Medical Center
When you need fast, effective medical care for pain, weight loss and walk in services.

Are You A New Patient?

New Patients: We will start to create a medical record file for you on your 1st visit. It is strongly recommended that you bring reports of any X-rays, MRI's, CT scans, Lab tests that you have. Please bring a report of your medical expenses from your pharmacy or pharmacies listing all the medications that you are currently taking along with medical records or consultation notes from your current or past pain management doctor or primary care physician, ER or any other specialist you have received treatment form. You will not be able to see a doctor without these reports. If you have never been to pain management before, the doctor will start your treatment by ordering some diagnostic tests. Please download these forms, print them out, answer completely to the best if your knowledge and put them in the mail, or bring them to your appointment. You can also fill these forms out online and send them back to us via email.

New Patient Forms:

Registration Form

Consent Agreement Form

PIP / Insurance Information

Assignment Of Benefits

Health Information Release Form

Patient History Form

Out Patient Services Form

Are You A Returning Patient?

Please take the time to fill out the below form explaining your previous visit and related medical conditions.

Follow Up Visit Form