Forms Download
Download New Patient Packet:
1. Click this link to download => New Patient Forms Packet • Established Patient Forms Packet
2. Print out and fill out patient forms.
3. Bring completed forms to your first office visit.
List of What to Bring on All Visits
APC wants to ensure you are seen quickly once you arrive and that your time with the physician is used effectively.
On all visits it will be helpful if you bring your:
• Current Insurance Card
• Photo ID
• Current Medications List
• Recent Medical Test Results
• Recent X-Rays, MRI’s, CT Scans, etc.
If your insurance has a co-pay for an office visit, you will be responsible to pay at the time of your visit.
First Visit Preparation
1. Download our Patient Forms Packet. Complete the forms and bring them with you to your first visit.
2. Record your history. Most people with chronic pain have extensive experience with the health care system. Describing this history in a thorough and chronological manner may be difficult, particularly if you are nervous about meeting a new physician. Nevertheless, it can be very useful to both you and your physician.
Write down the events that led to your chronic pain as well as surgeries or other therapies that have been used to treat the pain. Include the dates they occurred. Carefully describe your pain, including the following:
• Location: Note if there are multiple sites of pain (using a drawing can be helpful).
• Intensity: Using a 0 to 10 scale, where 0 means “no pain” and 10 means “worst possible”, describe the intensity of your usual, worst, and least pain.
• Quality: Select specific words to describe the pain, such as “aching”, “throbbing”, “tingling”, or “electrical”
• What makes the pain better?
• What makes the pain worse?
List the medicines, physical therapies, and all other interventions used in the past to manage your pain. For medicines,
include the dose and the number of days that you took the drug. If it caused side effects, list these too.
Think back to any past hospitalizations or surgeries when you might have received pain medications. If you remember, list the drug you received, how well it worked, and whether you experienced any side effects. Although this takes some effort, it will help your doctor know what drugs to avoid, saving you time (and possibly money) in the long run.
Remember that drugs can take a while to work. An inadequate trial in the past, or doses that were too low, might have led you to believe a certain drug did not work. Your doctor may find that at a higher dose, that drug may be very useful in managing your pain.
3. Bring all your current medications. Bring pill bottles, patches, creams and any other medicines that you currently take or use. Include all medications, not just those used for pain. Don’t forget to include over-the-counter medicines, vitamins, and herbal therapies. Although you may need a suitcase to carry all of these bottles, your doctor will appreciate being able to actually see the drugs and clarify the doses, whether they are generic or not, and other aspects.
For example, several drugs have different trade names when prescribed for different purposes. Careful review of all of these medicines can prevent duplication and potential adverse reactions.
4. Bring x-rays, CT scans, MRIs, and other scans. Our healthcare system is not as seamless as we would like. If your Doctor has to obtain these scans from other health care centers, it could delay treatment. And repeating these scans can
cost you money and time.
Bring the actual acans, not just the Radiologist’s report. This allows the doctor to make his or her own interpretation of the findings. In fact, you may wish to keep copies of these scans for your own records.
5. Make a list of questions. Write down questions you want to ask the doctor so you don’t forget anything important, such as:
• What do you believe is the cause of the pain?
• What strategies might help relieve the pain?
• What are the pros and cons of each approach?
• What side effects might occur?
• What is the long-term outlook?
• What are my responsibilities?
• What are the doctor’s responsibilities?
• How does he/she like to communicate (office visits only, telephone, email)?
• Is there another healthcare provider who should be contacted, such as a nurse or physician assistant?
• What part of my care will this Physician be responsible for—pain only or general medical care too?
6. Make a list of your goals. This is easier said than done. You may want to spend some time thinking about what you actually hope to achieve. Are you seeking complete relief of pain? Are you hoping to be able to work part time? Ride your bicycle? The more specific you can be the more precise your doctor can be in developing a plan of care to accomplish these goals.
In the book Managing Pain Before it Manages You, Margaret Caudill, M.D. recommends the following criteria when setting your goals:
• A goal should be measurable
• A goal should be realistic
• A goal should be behavioral
• A goal should be “I” centered
• A goal should be desirable
7. Bring a friend or family member to the doctor’s office. A second set of ears is very important when complex medical information might be discussed. A friend or family member can help you remember the Physician’s recommendations. You may also wish to tape the conversation so it can be played back later. This is especially important if you have memory loss, poor hearing, poor eyesight, or are dyslexic. Let the Doctor know you are taping the conversation and why.
8. Mentally prepare for the visit. Seeing a new Doctor for chronic pain is an occasion often filled with hope and optimism for possible cure. And yet, relaying the history of your pain and your attempts at finding relief can be emotionally trying.
Don’t be surprised if tears of frustration and sadness start to flow. I have sat with people during their first visit who cried during the entire appointment. Though this is to be expected (and a compassionate professional should respond with caring and support) it also limits your opportunity to talk with your doctor and develop a treatment plan.
Follow Up Visit Preparation
1. Bring a diary. While trying new therapies, listing your reactions in a diary can help you recall the results, the level of relief as well as any side effects. Writing things down frequently will help you remember to ask about them. And if you are pleased about some aspect of your progress, or you were able to do something you could not do in the past, let your doctor know this too. Let him or her join in celebration of your victories.
2. Bring a list of new questions. If your goals have changed, let your doctor know.
3. Bring your friend, family member, and/or tape recorder.
