Instructions for New Patients:
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DOWNLOAD THE VERSION OF QUESTIONNAIRE (THAT APPLIES TO YOU) TO YOUR DESKTOP AND SAVE.
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OPEN THE DOCUMENT SAVED ON YOUR DESKTOP, COMPLETE EVERY SINGLE ITEM AND SAVE AGAIN.
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EMAIL THE COMPLETED FORM TO: DrSiegelOffice@paincareflorida.com
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YOU MAY ALSO PRINT THE FORM, COMPLETE WITH PEN OR PENCIL AND FAX COMPLETED FOR TO 954-721-4200.
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PLEASE BRING PHOTO ID CARD, INSURANCE CARD AND CREDIT CARD FOR YOUR VISIT. CASH / CHECKS NOT ACCEPTED.
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PATIENTS ARE RESPONSIBLE FOR OBTAINING INSURANCE REFERRALS FROM PCP
For Patients Without Injury For Patients With Injury-Related Condition
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