Patient Information | Patient Forms | Pain Management of North Dallas
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Patient Information


New Patient Paperwork

Please click the link below, fill out the patient packet, download, print, and bring to your scheduled office visit.

  1. New Patient Form


Insurance Accepted

  1. Aetna
  2. Blue Cross Blue Shield
  3. Cigna
  4. Superior Ambetter Marketplace
  5. Tricare
  6. United Health Care
  7. Medicare


Before Your Appointment

New Patient Forms

Above are our New Patient Forms and Instructions. Please print these forms and fill them out completely prior to your appointment. It is important you have these patient forms completed before your appointment. If you are unable to print and complete these forms prior to your appointment then you will need to arrive 30 minutes before your scheduled appointment to complete the forms.

Physician Reports

We require your most recent physician reports and ALL radiology reports (X-rays, MRIs, CTs etc) be sent to our office by your treating physician PRIOR to your appointment. If you are unable to gather those items then we will need to reschedule your appointment.

What to Bring With You to Your First Appointment

  1. Completed Patient Forms
  2. Photo ID
  3. Current Insurance Card
  4. All medication bottles you are currently taking
  5. Any medical records that might be useful in your evaluation; labs, recent physical, IQ or psychological testing results, in addition for children also recent report card, behavior sheets.
  6. Ensure your new patient paperwork has been completed–make sure you have read and signed all forms. (You can still complete the forms when you arrive 30 minutes prior to your appointment time)

Please arrive at least 30 minutes prior to your first scheduled appointment time to complete registration and check-in, in order to maximize your appointment time.


Before Your Procedure

No Food or Drink

It is very important that you do not eat or drink anything 8 hours prior to your appointment. This includes gum, hard candy and mints. If you eat or drink within 8 hours of the procedure, we may be forced to cancel or reschedule for a later date. The only exception to not eating or drinking 8 hours prior to your procedure is if you are taking medication for seizures, high blood pressure, cardiac conditions, asthma, or acid reflux. If you are taking any f these types of medications, then take them first thing in the morning with a sip of water. All other medications can be taken after your procedure.


Arrive 1 hour prior to your procedure time.  If you are late we may need to reschedule your appointment so please be on time.

What to Bring

Bring your driver’s license (or photo ID), insurance card(s), and a list of ALL medications and dosage information that you are taking.

Driving Home

Make sure you have arranged to have someone drive you home. You will be unable to drive or operate any have machinery until the day after your procedure. Your ride must be present at the time of discharge, no exceptions.  Please note that you may not go home in a cab or any other community transport.

The Procedure

The procedure will begin with an IV and a short acting general anesthesia.  You will only be asleep for the duration of the procedure which typically lasts between 10 to 15 minutes. Patients usually awaken after about 5-10 minutes.


No prescriptions will be written on procedure days.  Prescriptions, including refills, will only be made at our office during an appointment.


If you have any questions, please call us at (214) 618-0853.

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