New Patient Forms
New patients can review and complete intake forms before their visit. Please bring completed forms, a list of current medications, and any relevant imaging or records to your appointment.
What to bring to your first appointment
- Completed intake forms (download below)
- Photo ID and insurance card(s)
- List of all current medications and dosages
- Any relevant imaging (X-rays, MRI, CT scans) on disc or printed report
- Referral paperwork if required by your insurance
- Prior medical records related to your pain condition
Downloadable Forms
Print and complete the forms below before your visit to save time at check-in. Adobe Acrobat Reader is required to open PDF files.
New Patient Instructions
Important information and instructions for your first visit to Newport Pain Management.
Patient Assessment Form
Comprehensive pain history and functional assessment — documents the nature, location, and impact of your pain on daily activities.
Headache Assessment Questionnaire
Detailed questionnaire for patients experiencing headaches, migraines, or facial pain.
Patient Partnership Plan
Outlines the mutual responsibilities and expectations between patient and physician for your care.
Financial Policy
Newport Pain Management financial policy, billing procedures, and payment expectations.
Notice of Privacy Practices
Describes how Newport Pain Management may use and disclose your protected health information (HIPAA).
Questions about your upcoming appointment?
Our team is happy to help. Call us during office hours.
Call (949) 759-8400