Patient Forms
Forms needed for your appointment.
Please download and complete the following forms, and then upload them via our link below. These Registration forms must be completed and signed prior to your appointment. Please read the authorization and policy forms thoroughly and sign and date.

Patient Registration Form

Download and fill out this form to become a patient of Interventional Pain Specialists.

Telehealth Form

This form is required for your telehealth appointment.

Referral Form

This form is for the use of the Referring Physician's Office to Interventional Pain Specialists.

Pain Medication Policy

Only needed to be printed and read if you have been referred for medication management.

Financial Policy

This is the financial policy covering the methods of payments for your treatment.

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Contact Information

Interventional Pain Specialists
James E. Wilson, M.D.

  Mon-Thur 8-4:00 pm
  Friday 8-1:00 pm
  Sat-Sun Closed
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