© Therapeutic Pain Management Medical Clinic 2016 - Site created by Dr. Dhruva 1335 Buenaventura Blvd, Ste 100, Redding, CA 96001. T: (530) 247-7246; (530) 24-7-P-A-I-N.   F: (530) 245-0849   email: mail@TPMclinic.com
Therapeutic Pain Management Medical Clinic (TPM)

Forms

Please click on the forms below to download them in a PDF format. If you need a form to be faxed or emailed to you, please contact us at (530) 247-7246 or via email to mail@TPMclinic.com

New Patient Questionnaire

If   you   are   being   seen   for   the   first   time   at   the   clinic   or   being   seen again   after   an   extended   period,   please   download   the   New   Patient Questionnaire      by      clicking      below.      Please      complete      the questionnaire   completely   prior   to   your   evaluation.   The   data   from this   form   is   entered   in   the   EMR   (Electronic   Medical   Record)   and becomes   a   part   of   your   permanent   medical   record   at   TPM.   Please note   that   you   can   not   save   your   data   entered   in   the   PDF.   You   will need to print it on a printer.

 

Instructions for Procedure 

These instructions are extremely important for safety during your procedure. It has eating & drinking instructions, medications to be stopped before your procedure as well as followup appointment information.

 

Medication Justification Form

For our work-comp patients, please use this form to describe how the medication(s) prescribed and paid for by work-comp is/are helping. This may help approval of such medication(s).
Click Here Click Here Click Here Click Here Click Here Click Here Improving Quality of Life
© Therapeutic Pain Management Medical Clinic 2016 Web designed and  created by Dr. Dhruva
Therapeutic Pain Management Medical Clinic

Forms

Please click on the forms below to download them in a PDF format. If you need a form to be faxed or emailed to you, please contact us at (530) 247-7246 or via email to mail@TPMclinic.com

New Patient Questionnaire

If   you   are   being   seen   for   the   first   time   at   the   clinic   or   being   seen   again   after   an extended   period,   please   download   the   New   Patient   Questionnaire   by   clicking below.   Please   complete   the   questionnaire   completely   prior   to   your   evaluation. The   data   from   this   form   is   entered   in   the   EMR   (Electronic   Medical   Record)   and becomes   a   part   of   your   permanent   medical   record   at   TPM.   Please   note   that you   can   not   save   your   data   entered   in   the   PDF.   You   will   need   to   print   it   on   a printer.

 

Instructions for Procedure 

These instructions are extremely important for safety during your procedure. It has eating & drinking instructions, medications to be stopped before your procedure as well as followup appointment information.

 

Medication Justification Form

For our work-comp patients, please use this form to describe how the medication(s) prescribed and paid for by work-comp is/are helping. This may help approval of such medication(s).
Click Here Click Here Click Here Click Here Click Here Click Here Improving Quality of Life