Patient Information

Home/Patient Information

Patient Forms

To make your first visit to our clinic as simple as possible, we’ve included our patient forms on our website which can be filled out prior to your appointment.

As a courtesy to our patients, our office files claims with most insurance plans. Please be sure to provide us with your current insurance information and notify us of any changes in your coverage. All co-pays and deductibles are due at the time of service, as well as office and/or hospital procedure coinsurance fees. We gladly accept cash, checks, debit or credit cards. Our billing personnel are available to discuss any issues or concerns you may have concerning your bill.

If you have any questions about patient forms or insurance, please call our office at 704-797-0065. We are happy to help.

Click Here – New Patient Forms
Click Here – Physician Referral Sheet


For all pain-related emergencies after office hours, please call, 704-210-5000. 
Please ask the operator to contact the person on call for Piedmont Interventional Pain Care.
Please also remember that night and weekend prescriptions will not be honored and must be arranged during office hours.


Click Here to go to your FAQ’s