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9834 Genesee Ave

Suite 411
La Jolla, CA 92037

15725 Pomerado Road
Suite 107
Poway, CA 92064

Phone: (858) 453-7700
Fax: (858) 798-1225

bulletCONTACT US


 

Patient Forms

In order to improve patient care and efficiency we have made some of our forms available for you to download. New patients please click here, please download and complete the following patient forms.

Dr. Chisholm’s New Patient Forms
Save time !!! Fill out your forms online!! Your confidential answers are sent to your provider for review prior to your appointment.
Online Demographics form
Demographics (PDF)
Online Evaluation form
Initial Evaluation (PDF, 122Kb)

Dr. Kovner’s New Patient Forms
Save time !!! Fill out your forms online!! Your confidential answers are sent to your provider for review prior to your appointment.
Online Demographics form
Demographics (PDF)
Initial Evaluation (PDF, 92 Kb)

Other Patient Forms
Authorization for Communication (PDF, 128Kb)
Records Transfer Request (PDF, 18Kb)
24 hour pain log (PDF, 54Kb)
Office Policies (PDF, 69Kb)
Patient's Financial Responsibility (PDF, 91Kb)
Post Procedure Instructions (PDF, 68Kb)

FAQ
Spinal Cord Stimulator Frequently Asked Questions (PDF, 89Kb)
Helpful Hints to Avoid Constipation (PDF, 12Kb)

 Additional Information
Spinal Cord Stimulation:
Boston Scientific
Advanced Neuromodulation Systems

Intrathecal Pump Therapy:
Medtronic

Useful Links
National Pain Foundation
American Academy of Pain Medicine
Pain.com
• RedToeNail.org

 


Copyright © 2007, Comprehensive Pain Managment Specialists
Christopher Chisholm, M.D.
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