Patient Forms

For Your Appointment

Thank you for choosing Pain Specialists of Columbia!  Our goal is to provide top quality care to our patients in a compassionate and professional environment. We do our best to stay on time with our schedule and give you our undivided attention.

As a patient of Pain Specialists of Columbia, please adhere to the following guidelines:

  1. If you are unable to keep an appointment, kindly call our office at (803) 252-4900 at least 24 hours prior to your appointment. We can then reschedule your appointment to a more convenient time. A $25 fee will be applied to all New Patient or Follow-Up appointments and a $75 fee for all Procedure appointments not canceled within the 24 hour period or if you fail to keep your appointment. Missed appointment fees are not paid by insurance
  2. Please arrive 15 minutes prior to your appointment time and bring a photo ID and your health insurance card. It is important to have your questionnaire and registration forms completed. If the forms are not complete at the time of your appointment, or you are more than 10 minutes late, you may need to be rescheduled for a later date
  3. Cash payments and co-payments must be paid at the time of check-in. We do not accept checks for the initial consultation. Full payment is due at the time services are rendered unless prior arrangements have been made. We accept Cash, Checks, Visa and Mastercard
  4. If your account becomes past due, no appointments or prescription refills will be given to you until your account has been cleared by the Billing Office.

FORMS