Patient Forms

Thank you for choosing SOAR as your pain management provider. You will find enclosed the new patient paperwork, your appointment information and a map to your chosen facility. If you have any questions or concerns, please feel free to contact the New Patient Coordinator.

To help expedite your treatment, to ensure your privacy and to correctly file your insurance claims, we ask that you carefully read over the following information and provide the required identification.

  1. Please provide our office with your correct insurance card (primary, secondary and tertiary) and photo identification, such as driver’s license and social security card. It is required these items are to be submitted at the time you check-in.
  2. Please provide your most recent medical records, which would include any imaging reports pertaining to your condition. If your PCP (primary care physician) referred you to our office, please contact them to request that they submit any medical records and/or imaging reports to our office. If you are a self-referred client, please obtain the medical records pertaining to your pain and either bring them to your appointment or have them faxed (321-733-7970). It is your responsibility to ensure that these records are provided to our physicians.
  3. It is your responsibility to obtain authorization for any office visits including your initial consultation if your insurance requires said authorization. This would be obtained from your PCP. Please ensure that your PCP has your correct insurance information when requesting an appointment to our facility. If an authorization is not obtained and is required, you may incur fees from your visits.
  4. Finally, there may come a time when you require additional medical and/or insurance forms to be completed by our office. They may include, but are not limited to, Disability Forms, Workers’ Compensation Forms, Attending Physician Statement, Leave of Absence forms, etc. This will not apply to most patients. However, in order to accommodate these requests, it will necessitate reviewing the chart, staff time and office resources. Therefore, a reasonable fee for such services will be applied. The fee for completing said forms is $150.00. Forms will not be completed until this fee is received.
  5. Every effort will be made to have these forms completed within a 5-7 business day turn-around from the time the fee is received. Please note that if the provider is out of the office there may be a longer delay. This would only apply to completing and filling out above-mentioned forms and NOT for completing the enclosed paperwork you received as a new patient to our facility.

Please arrive at your scheduled appointment 30 minutes prior to your appointment time and bring the completed paperwork you received from our office, insurance cards and photo identification. Please note that photo identification is REQUIRED at the time of appointment for any patient and failure to provide said photo identification will result in a cancellation of the appointment.

If you have any questions, please feel free to contact this office. Thank you for choosing SOAR.

In order to help us help you during your office visit, please review and use the following forms.

New Patients

The “New Patient Packet” contain forms which you will be required to complete for your first visit. Please download the forms and provide the requested information. At the time of registration you will also be asked to present your driver’s license and insurance cards for verification.

New Patient Packet Includes:

Welcome Letter; Information Demographics Financial Disclosure Form; Consent and Consent to Treat Others Form; HIPAA Contact Information Form; Protected Health Information Release and Request of Medical Records Form; Advance Directives Form; Spinal Pain Patient Questionnaire; Informed Consent for Opioid Treatment for Non-Cancer/Cancer Pain; Agreement for Opioid Treatment for Non-Cancer/Cancer Pain; Patient Rights and Responsibilities

Patient Packet

Patient packet coming soon

Other Forms

Identity Verification / Documentation Needed for Office Visit Information Form; HIPAA Notice of Privacy Practices (2 forms front and back/ English and Spanish); Patient Rights (2 forms front and back/ English and Spanish)

Patient Referrals

Patient referral forms coming soon