Become a Patient

Become a New Patient

We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:

1. Request an Appointment
2. Sign up for our MyPrivia patient portal
3. After your appointment is confirmed, you will receive email and text messages asking you to complete pre-registration on your phone, tablet, or computer. You will continue to receive reminders until the process is complete.

1. Download the MyPrivia App to make appointments, message your provider, or get care on the go.

When you see us for the first time, whether in person or by telemedicine, please complete all steps of our electronic pre-registration process prior to your appointment. Please also have on hand:

• Your referral (if any)
• A list of your doctors
• A list of your medications and allergies
• The name and location of your pharmacy
• Medical test and imaging reports
• Any images you might have pertaining to your pain problem

Any documentation, such as imaging reports and referrals, may be scanned and submitted via the MyPrivia Patient Portal (send a message to Customer Service), via our secure email portal, or faxed to (240) 813-1193. Please do not use your personal email account to send this confidential health information.

To make sure there are no delays in care during your first visit experience, please complete the electronic intake and arrive (or be available by telephone for your virtual visit) 15 minutes prior to your appointment time to ensure your registration is complete before meeting with your new doctor.

If you have an in-office appointment and are unable to complete electronic pre-registration prior to your appointment, please arrive at least 45 minutes ahead of your appointment to allow time to complete intake in the office. In that case, in addition to the items listed above, you will also need to bring:

• Your insurance card
• Valid photo ID
• Office co-pay

In an effort to respect the time of all of our patients, our staff strives to stay on schedule so that other patients do not have to wait.

For patients who arrive late to an appointment for any reason, every effort will be made to see them the same day. However, additional wait times may apply, or appointments may need to be rescheduled so as not to inconvenience our other patients.

Patient Forms

Prior to your first appointment, you will be asked to review and sign some of these forms as part of our electronic intake process.  Signed forms can then be printed from the patient portal. You can also review and print unsigned forms below.

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Office Policies 

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Politica Financiera

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de Practicas de Privacidad

Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Pain Management Specialists Office and Surgery Center Policies (PDF) - This document includes notices and policies concerning missed appointments, prescription refills, billing, surgery center ownership, closure for inclement weather, etc. Políticas de consultorios y centros de cirugía