{"id":2628,"date":"2020-06-25T21:47:57","date_gmt":"2020-06-25T21:47:57","guid":{"rendered":"https:\/\/centerforpainfargo.com\/?page_id=2628"},"modified":"2022-02-08T03:41:32","modified_gmt":"2022-02-08T03:41:32","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/centerforpainfargo.com\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"
[et_pb_section fb_built=”1″ _builder_version=”3.29.3″ background_image=”https:\/\/centerforpainfargo.com\/wp-content\/uploads\/2019\/07\/016-MyanmarWEB.jpg” custom_padding=”100px||200px|” z_index_tablet=”500″ box_shadow_horizontal_tablet=”0px” box_shadow_vertical_tablet=”0px” box_shadow_blur_tablet=”40px” box_shadow_spread_tablet=”0px” global_colors_info=”{}”][et_pb_row make_equal=”on” custom_padding_last_edited=”on|desktop” _builder_version=”4.13.1″ background_color=”#ffffff” background_color_gradient_direction=”120deg” max_width=”1280px” custom_padding=”50px|40px|50px|40px” custom_padding_tablet=”80px|60px|80px|60px|true|true” custom_padding_phone=”|40px||40px|false|true” animation_style=”fold” hover_enabled=”0″ z_index_tablet=”500″ border_radii=”|60px||60px|” box_shadow_style=”preset2″ box_shadow_horizontal=”40px” box_shadow_vertical=”40px” box_shadow_blur=”80px” box_shadow_color=”rgba(6,10,76,0.19)” global_colors_info=”{}” column_structure=”1_3,2_3″ link_option_url=”https:\/\/centerforpainfargo.com\/wp-content\/uploads\/2022\/02\/Combined-Patient-Forms-2022.pdf” sticky_enabled=”0″][et_pb_column type=”1_3″ _builder_version=”3.0.47″ custom_padding=”|||” hover_enabled=”0″ global_colors_info=”{}” custom_padding__hover=”|||” sticky_enabled=”0″][et_pb_image src=”https:\/\/centerforpainfargo.com\/wp-content\/uploads\/2015\/03\/pdf-icon.jpg” _builder_version=”4.13.1″ _module_preset=”default” alt=”pdf icon” title_text=”pdf icon” url=”\/wp-content\/uploads\/2022\/02\/Combined-Patient-Forms-2022.pdf” hover_enabled=”0″ sticky_enabled=”0″][\/et_pb_image][\/et_pb_column][et_pb_column type=”2_3″ _builder_version=”3.0.47″ custom_padding=”|||” hover_enabled=”0″ global_colors_info=”{}” custom_padding__hover=”|||” sticky_enabled=”0″][et_pb_text _builder_version=”4.13.1″ _module_preset=”default” hover_enabled=”0″ sticky_enabled=”0″]<\/p>\n
Download your patient forms by clicking the PDF icon to the left. Complete and return prior to your appointment at Center for Pain Medicine.\u00a0 Please contact us with any questions you may have prior to your appointment.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”3.24″ background_color=”#ffffff” inner_width_tablet=”50px” inner_max_width_tablet=”100px” inner_max_width_phone=”50px” z_index_tablet=”500″ box_shadow_horizontal_tablet=”0px” box_shadow_vertical_tablet=”0px” box_shadow_blur_tablet=”40px” box_shadow_spread_tablet=”0px” global_module=”2287″ global_colors_info=”{}”][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ admin_label=”row” _builder_version=”3.25″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”3.0.47″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Accepted Insurances” url=”\/accepted-insurances\/” image=”https:\/\/centerforpainfargo.com\/wp-content\/uploads\/2015\/02\/homepage-curcle-buttons-bottom-panel-insurance.png” alt=”Accepted Insurances” image_icon_width=”none” admin_label=”ACCEPTED INSURANCE” _builder_version=”4.13.0″ header_font=”Work Sans|600|||||||” background_size=”initial” background_position=”top_left” background_repeat=”repeat” max_width_tablet=”50px” link_option_url=”\/accepted-insurances\/” z_index_tablet=”500″ header_text_shadow_horizontal_length_tablet=”0px” header_text_shadow_vertical_length_tablet=”0px” header_text_shadow_blur_strength_tablet=”1px” body_text_shadow_horizontal_length_tablet=”0px” body_text_shadow_vertical_length_tablet=”0px” body_text_shadow_blur_strength_tablet=”1px” body_link_text_shadow_horizontal_length_tablet=”0px” body_link_text_shadow_vertical_length_tablet=”0px” body_link_text_shadow_blur_strength_tablet=”1px” body_ul_text_shadow_horizontal_length_tablet=”0px” body_ul_text_shadow_vertical_length_tablet=”0px” body_ul_text_shadow_blur_strength_tablet=”1px” body_ol_text_shadow_horizontal_length_tablet=”0px” body_ol_text_shadow_vertical_length_tablet=”0px” body_ol_text_shadow_blur_strength_tablet=”1px” body_quote_text_shadow_horizontal_length_tablet=”0px” body_quote_text_shadow_vertical_length_tablet=”0px” body_quote_text_shadow_blur_strength_tablet=”1px” box_shadow_horizontal_tablet=”0px” box_shadow_vertical_tablet=”0px” box_shadow_blur_tablet=”40px” box_shadow_spread_tablet=”0px” box_shadow_horizontal_image_tablet=”0px” box_shadow_vertical_image_tablet=”0px” box_shadow_blur_image_tablet=”40px” box_shadow_spread_image_tablet=”0px” text_shadow_horizontal_length_tablet=”0px” text_shadow_vertical_length_tablet=”0px” text_shadow_blur_strength_tablet=”1px” image_max_width=”none” global_colors_info=”{}”]<\/p>\n
\u00a0<\/p>\n
View<\/a> <\/strong>a complete list of insurances.<\/p>\n \u00a0<\/p>\n [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.0.47″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Patient Portal” url=”\/patient-portal\/” image=”https:\/\/centerforpainfargo.com\/wp-content\/uploads\/2015\/02\/homepage-circle-button-patient-portal.png” alt=”PATIENT PORTAL” admin_label=”PATIENT PORTAL” _builder_version=”4.13.0″ header_font=”Work Sans|600|||||||” background_size=”initial” background_position=”top_left” background_repeat=”repeat” max_width_tablet=”50px” z_index_tablet=”500″ header_text_shadow_horizontal_length_tablet=”0px” header_text_shadow_vertical_length_tablet=”0px” header_text_shadow_blur_strength_tablet=”1px” body_text_shadow_horizontal_length_tablet=”0px” body_text_shadow_vertical_length_tablet=”0px” body_text_shadow_blur_strength_tablet=”1px” body_link_text_shadow_horizontal_length_tablet=”0px” body_link_text_shadow_vertical_length_tablet=”0px” body_link_text_shadow_blur_strength_tablet=”1px” body_ul_text_shadow_horizontal_length_tablet=”0px” body_ul_text_shadow_vertical_length_tablet=”0px” body_ul_text_shadow_blur_strength_tablet=”1px” body_ol_text_shadow_horizontal_length_tablet=”0px” body_ol_text_shadow_vertical_length_tablet=”0px” body_ol_text_shadow_blur_strength_tablet=”1px” body_quote_text_shadow_horizontal_length_tablet=”0px” body_quote_text_shadow_vertical_length_tablet=”0px” body_quote_text_shadow_blur_strength_tablet=”1px” box_shadow_horizontal_tablet=”0px” box_shadow_vertical_tablet=”0px” box_shadow_blur_tablet=”40px” box_shadow_spread_tablet=”0px” box_shadow_horizontal_image_tablet=”0px” box_shadow_vertical_image_tablet=”0px” box_shadow_blur_image_tablet=”40px” box_shadow_spread_image_tablet=”0px” text_shadow_horizontal_length_tablet=”0px” text_shadow_vertical_length_tablet=”0px” text_shadow_blur_strength_tablet=”1px” global_colors_info=”{}”]<\/p>\n Log in<\/a><\/strong> to email the clinic, request an appointment, pay your bill, view your chart.<\/p>\n [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.0.47″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Patient Referrals” url=”https:\/\/centerforpainfargo.com\/refer-a-patient-2\/” image=”https:\/\/centerforpainfargo.com\/wp-content\/uploads\/2019\/09\/homepage-circle-button-referrals.png” alt=”PATIENT REFERRALS” admin_label=”PATIENT REFERRALS” _builder_version=”4.13.0″ header_font=”Work Sans|600|||||||” background_size=”initial” background_position=”top_left” background_repeat=”repeat” max_width_tablet=”50px” link_option_url=”https:\/\/centerforpainfargo.com\/refer-a-patient-2\/” z_index_tablet=”500″ header_text_shadow_horizontal_length_tablet=”0px” header_text_shadow_vertical_length_tablet=”0px” header_text_shadow_blur_strength_tablet=”1px” body_text_shadow_horizontal_length_tablet=”0px” body_text_shadow_vertical_length_tablet=”0px” body_text_shadow_blur_strength_tablet=”1px” body_link_text_shadow_horizontal_length_tablet=”0px” body_link_text_shadow_vertical_length_tablet=”0px” body_link_text_shadow_blur_strength_tablet=”1px” body_ul_text_shadow_horizontal_length_tablet=”0px” body_ul_text_shadow_vertical_length_tablet=”0px” body_ul_text_shadow_blur_strength_tablet=”1px” body_ol_text_shadow_horizontal_length_tablet=”0px” body_ol_text_shadow_vertical_length_tablet=”0px” body_ol_text_shadow_blur_strength_tablet=”1px” body_quote_text_shadow_horizontal_length_tablet=”0px” body_quote_text_shadow_vertical_length_tablet=”0px” body_quote_text_shadow_blur_strength_tablet=”1px” box_shadow_horizontal_tablet=”0px” box_shadow_vertical_tablet=”0px” box_shadow_blur_tablet=”40px” box_shadow_spread_tablet=”0px” box_shadow_horizontal_image_tablet=”0px” box_shadow_vertical_image_tablet=”0px” box_shadow_blur_image_tablet=”40px” box_shadow_spread_image_tablet=”0px” text_shadow_horizontal_length_tablet=”0px” text_shadow_vertical_length_tablet=”0px” text_shadow_blur_strength_tablet=”1px” use_border_color=”off” global_colors_info=”{}”]<\/p>\n \u00a0<\/p>\n