What Paperwork Will You Need?

To provide you with the best possible care and treatment at PMIR Medical Center, we must gather important information about your medical history and current physical condition. We also need to have up-to-date emergency contacts and insurance information. For your convenience, these forms are available below. Please bring the completed forms with you when you come to our facility for your doctor’s appointment or procedure. If you choose not to fill out the forms before your procedure, please arrive at least 15 minutes early to complete the forms, and bring copies of your:

  • Drivers license or approved government identification card
  • Valid insurance card
  • Drug and allergy list
  • Patient Rights Form

New Patient Forms

Make An Appointment Today

To learn more about how we can help relieve your pain, contact us directly via our online form or request an appointment today by calling (855) 764-7633