This form is so any other providers you have seen can send your records to us so we can have a complete medical history. Jacksonville Spine and Pain Center will also use this form to release or send your medical records to another provider on your behalf. Please fill out the form completely, sign it, and date it.
This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it, fill out the brief form, sign it, and date it.
This is a very important packet. These forms provide us with your contact information, insurance, whether your injury is a result of a workman’s comp incident or auto accident. It also requests details about your pain, existing/previous medical conditions and what medications you are currently taking. It is a very comprehensive document and you will save a great deal of time in the waiting room if you fill this out prior to your appointment.
For your convenience, here is a list of the insurance we accept:
Blue Cross Blue Shield
Department of Labor
United Health Care
Most Commercial Carriers