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Patient Forms

New Patients:

Please print the document below titled "Download new patient packet". Please be sure to complete this packet in its entirety before your appointment and bring it with you. If you have not completed this packet your appointment will have to be rescheduled. Please bring the following items with you:

  • Your insurance card or cards
  • Your driver’s license or picture I.D.
  • The packet of COMPLETED forms
  • If your insurance company requires a doctor’s letter of referral, please BRING IT WITH YOU
  • Payment for your co-pay, and or deductible if not met this year. If you do not bring your copay amount, your appointment will be rescheduled.

* If your visit is covered by work comp, please call us prior to your appointment with the name and phone number of your case manager so we can verify coverage.

As a new patient your appointment will take significantly longer than a follow up visit. Dr. Cosgrove is dedicated to providing all of our new patients with an extensive exam and a thorough consultation in order to assess your pain management needs.

Thank you for choosing PainSouth!

ALL PATIENTS MUST BRING ALL MEDICATIONS PRESCRIBED BY ANY PHYSICIAN TO EACH APPOINTMENT

Downloads:

Click here to download Adobe Reader for free.Please note that the following patient forms are in Adobe Acrobat PDF format. They require Adobe Reader to be viewed. If you do not already have Adobe Reader, you may download it for free by clicking here.

> Download New Patient Packet (334 KB PDF)
> Medication List (9.90 KB PDF)
> Patient & Insruance Information (30.7 KB PDF)
> HIPAA (35.4 KB PDF)
> Privacy Notice (52.9 KB PDF)

 
 


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PainSouth, Inc. St. Vincent's Hospital, Building II, 2700 10th Avenue South, Suite #444, Birmingham, AL 35205 | P: 205-297-9801 | F: 205-297-9804
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