Patient Information


 

Health History 

The Health History Form is for patients to download and complete.  The form can be faxed to our office at the number listed at the bottom of this page or brought to the office for the patient’s first appointment.

Download Health History Form

 

Demographic Form

The Demographic is for patients to download and complete.  The form can be faxed to our office at the number listed at the bottom of this page or brought to the office for the patient’s first appointment.

Download Demographic Form

 

Release of Medical Record Information

The Release of Medical Record Form is for patients to download and complete.  The form can be faxed to our office at the number listed at the bottom of this page or brought to the office for the patient’s first appointment.

Download Release of Medical Record Information Form

Please fax completed forms to (989) 752-1901



Location
Pain Consultants of Michigan
1119 South Washington Avenue
Saginaw, MI 48601
Phone: 989-752-1900
Fax: (989) 752-1901
Office Hours

Get in touch

989-752-1900