Emerald Coast Pain Services


We require that the new patient form be delivered to our office before we will schedule your appointment. We require this since we have found that this reduces no show appointments and thus allows us not to over book patients like many doctors do. This allows us to be on time for your appointment and minimize delays for you. We pride ourselves on generally being ontime.

Our New Patient Form


Please Complete the new patient form and either fax it, email it, mail it or bring it to us in person. We will not set up a new appointment without the form completed. We also suggest you complete the other forms below as well.


The Forms below may be required but can be done when you arrive at the office for your new patient appointment. We do suggest that you download them and read them beforehand.


Also, we apologize for the length of the forms. Much of the information is required by either the government or insurance companies.


Narcotic Medication Agreement (If you currently get your medications elsewhere or do not require controlled substances then you can skip this)


Office Policies Form (Form explaining office hours, late fees, etc.)


HIPPA Form (Form to allow us to send your information to your insurance company for payment)


Aurthorized Release (Form to allow us to get records from other facilities about you such as MRI's, X-rays, etc)


Privacy Notices (Form explaining your privacy rights) 


ECPS policies (General Billing Policy Information)