Forms, Instructions & Insurance
Einstein Pain Institute - Additional Resources
Patient Intake Form
Some people find it difficult to talk about pain — to find just the right words to describe what the pain feels like or to remember when it was at its worst, or when they last felt their best. We often use a form like this Patient Intake Form to help them create a complete “picture” of a chronic pain problem. The questions ask about pain symptoms and about medications, how well they worked and about any side effects they may have caused. If you suffer from chronic pain, it might be a good idea to fill out this intake form and bring it with you when you see your Einstein Pain Institute specialist next. You can download it and print it out. The information may be helpful for both you and your doctor.
Download the Welcome letter and instructions here.
Download the Patient Intake form here.
Download the Patient Medical History form here.
Download all three files together here.
The documents presented here require the free Adobe Acrobat Reader software to view. Click on the icon to go to the Adobe Acrobat download page.
Medial record and films should be brought to your first appointment.
Referrals, insurance cards & information and copays are to be brought to each appointment.