New Patient Forms
We appreciate your selection of our office for your spine care needs. We strive to provide the highest quality of professional care at the best possible value. You can help us anticipate special needs by telling us more about yourself.
For your convenience you may print and complete the forms listed here prior to your appointment and provide it to our receptionist when you arrive. If you do not have access to a printer we will mail you the appropriate forms to fill out prior to your appointment.
Your insurance may require you to have a referral for you to receive care from one of our providers. So, please contact your insurance company to make sure that if you do need a referral, your primary care doctor has provided one for you.
Our providers would like to review any x-rays, M.R.I.’s, CT Scans or other tests that you may have had performed in the past relating to your problem. Please make sure that you bring any of these tests with you when you come for your first appointment. Without this information, we may have to reschedule your visit. For children under the age of 17, we ask that their legal guardian accompany them for their initial visit. This allows us to have parental consent for treatment.
At this time we would also like to inform you that we require 24-hour notification for cancellations and there is a $35.00 charge for no show patients.
After your visit, we may ask if you would complete a patient satisfaction form for us. We need your help in assisting us to become a better clinic and these forms are an important way for us to know how well we are doing. We know you have a choice when it comes to your medical care and we appreciate you choosing Spine Institute of Idaho.
Sincerely,
The Staff of Spine Institute of Idaho
Joseph Verska, M.D.
Samuel S. Jorgenson, M.D.