New Patients
- Please download, print and complete the "New Patient Registration Packet" and bring this to your visit
- Insurance Card
- Drivers license or valid photo identification
- Payment for any applicable co-pays
- Any relevant MRI/CT/X-ray or other studies including lab work
For New Patients Requesting Consultations
A new patient requesting a consultation with Dr. Mark Moran that has an HMO insurance policy should contact their Primary Care Physician (PCP) to refer them to pain management. A referral is required with this type of policy. In addition, please have your primary care doctor fax the following to the New Patient Department:
- Progress Notes
- MRI / CT
- Demographics
- Insurance Information
- Medication List
A new patient requesting a consultation with Dr. Mark Moran that has a PPO insurance policy (most of the time) will not require a referral from a Primary Care Physician (PCP); therefore you can self-refer by filling out the form provided on this page. If you have been treated by a primary care, urgent care or emergency room doctor for pain, we will request medical records and will need to have them prior to scheduling your appointment. Dr. Moran prefers to have as much information as possible to better serve you.
For New Patients Requesting Consultations
Please Fax:
- Last three (3) progress notes
- Any radiology pertaining to patient's pain
-
Demographics with insurance information
(copy of insurance preferred) - List of medications
- Procedure recommendations (ESI's, trigger points, etc.)
**A scheduler will call the patient to set up an appointment and notify the referring doctor of appointment confirmation.**
Procedure Instructions
Patient Forms
- New Patient Registration Packet (100KB - PDF)
- Patient Responsibility Agreement for Dr. Moran's Team (347KB - PDF)
- Informed Consent & Pain Medicine Agreement 2024 (380KB - PDF)
- Authorization for Release of Information (New Patient) (101KB - PDF)
- Authorization for Release of Information (ROI) (65KB - PDF)
- Notice of Privacy Practices (25KB- PDF)
- REMS Patient Counseling Guide
- New Man Sheet
Office Policies
As we welcome you to our team, we want to make sure you are up to speed with the beliefs and foundations of our practice.
Payment Policy and Accepted Insurances
We work with you and your circumstances to maximize your treatment plan. These include:
- Worker's Compensation
- Personal Injury Cases
- Medicare
- Private Pay
We accept most insurances.
All co-pays and deductibles are due at the time of check-in, including private pay. Most all Medicare Supplement Plans accepted.
