Dear New Pain Management Patient,

Welcome to Ohio Valley Pain Institute. Please take a few moments to carefully and completely fill out the following questions regarding your pain history and medical history. Accurate completion of this form is important, so please ask the receptionist or the nurse if you have any questions. When choices are given, mark the answer that is most correct. At Ohio Valley Pain Institute, your time is important to us. We greatly appreciate you arriving on time and will always do our best to stay on schedule. Occasionally, we do get behind schedule because of emergencies or because prior patients have required more time for their appointment then we had anticipated. In the event that this happens, please be assured that you will be seen as soon as possible and always in the order which you were scheduled.