Patient Forms

New Patients Forms

The Denver Spine and Pain Institute welcomes you to our practice!

• Dear New Patient

Please complete these forms before your first visit, and check-in 10 minutes prior to your appointment:

• Spine Health History
• Patient Information Form
• Confidential Communication Request
• Payment Policy
• Online Communications Informed Consent

Existing Patient Forms

• Follow Up Form

Additional Forms

• Privacy Policy
• Medical Release Form

In some cases, you may also be asked to fill out these function-related questionnaires:

• Oswestry Disability Index (ODI for low back pain)
• Neck Disability Index (NDI neck pain)
• DASH Questionnaire (arm or hand pain)
• LEFS Questionnaire (leg or foot pain)

For referrals to Physical Therapy:

• Physical Therapy Referral: Denver Back Pain Specialists

For referrals to Dr. Bainbridge and Dr. Trainor:

• Referral Form: Denver Back Pain Specialists

Additional Practice Information and Disclosures:

• Notice of Physician Business Relationships
• Injection Information and Forms