Pain Management And Injury Relief Medical Centers (PMIR)

Patient Forms

We want to know as much about you as possible about you and your pain. Further, we want to respect the time that you spend with us here. We know that you're busy and that you, like the professionals at PMIR, want your time at one of our offices to be used as efficiently as possible. Thus, we appreciate your downloading and filling out these forms, in as much detail as possible, before your visit so that we can review them with you during our initial consultation.

• Patient Questionnaire and History

• Notice of Privacy Practices

• Insurance Assignment & Release

SERVING THE GREATER THE LOS ANGELES AREA AND VENTURA COUNTY

SANTA MONICA    2336 Santa Monica Blvd., Suite 208, Santa Monica, CA 90404 • Phone: 310.917.6800 • Fax: 310.917.6804
THOUSAND OAKS    425 Haaland Drive Suite 101, Thousand Oaks, CA 91361 • Phone: 805.557.0096 • Fax: 805.557.7360
SIMI VALLEY    Medical Center Opening in January 2012