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Arizona 623.516.8252 | Florida 386.274.2977

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Forms

Please click on the links below to download our patient forms.

Insurance

Authorization To Release Medical Information
Notice of Privacy Practices HIPAA
Notice of Privacy Practices HIPAA Spanish
Patient Rights & Responsibilities

Referrals

Fax-A-Referral Greater Phoenix
Fax-A-Referral Prescott
Fax-A-Referral Tucson

Common Conditions Treated

Back Pain
Neck Pain
Leg Pain
Joint Pain
Pelvic Pain
Arm Pain
Abdominal Pain
Head Pain
Foot Pain
Total Body Pain

Not sure? See all conditions.

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Why The Pain Center?
Arizona & Florida Locations
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What Our Referrals Are Saying

Locations

Arizona

Gilbert,

Gilbert
Peoria,

Peoria
Phoenix,

Arcadia
Phoenix,

Deer Valley
Phoenix,

Paradise Valley
Phoenix,

Phoenix Surgical Center
Phoenix,

West Phoenix
Prescott,

Prescott
Surprise,

Surprise
Tempe,

Tempe
Tempe,

Tempe Surgical Center
Tucson,

'A' Mountain

Florida

Daytona Beach,

Daytona
Daytona Beach,

Ormond Beach
DeLand,

DeLand
Jupiter,

Jupiter
Lake Mary,

Lake Mary
New Smyrna Beach,

New Smyrna
Orange City,

Orange City
Ormond Beach,

Alliance Specialty Surgical Center
Palm Coast,

Palm Coast
Port Orange,

Port Orange

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Arizona 623.516.8252
Florida 386.274.2977
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