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Patient Resources

Online Forms

Download the forms you need before your visit. Completing your paperwork ahead of time helps us provide the best possible care from the moment you arrive.

Patient Paperwork

Please complete the appropriate paperwork before your appointment. New patients can complete everything securely online — no printer required — using the Complete New Patient Forms Online button on the New Patient Packet card below. You may also print any packet, fill it out, and bring it with you. If you have any questions about which forms to complete, please call us at (251) 291-2311.

New Patients

New Patient Packet

Required for all first-time patients. Complete your paperwork securely online — no printer needed — or download the packet to print and bring with you. Please also bring a valid photo ID and insurance card(s) to your initial appointment.

📝   Complete New Patient Forms Online ⬇   Download Packet to Print (PDF)
Follow-Up Visits

Follow-Up Patient Packet

Required for established patients returning for follow-up visits. Please complete and bring to your scheduled follow-up visit.

⬇   Download Follow-Up Packet
New Patients

Financial Policy & Assignment of Benefits

Outlines our billing practices, insurance filing procedures, copay and deductible obligations, and assignment of insurance benefits to the practice.

⬇   Download Financial Policy
New Patients

HIPAA Notice of Privacy Practices

Describes how your protected health information may be used and disclosed, your rights under HIPAA, and how to file a complaint. Includes acknowledgment of receipt signature page.

⬇   Download HIPAA Notice
New Patients

Opioid Agreement

Required for patients who may be prescribed controlled substances. This agreement outlines the responsibilities of both the patient and the provider in the management of opioid therapy.

⬇   Download Opioid Agreement
New Patients

NPO Guidelines for Adults & Teenagers

Pre-procedure fasting instructions for patients scheduled for interventional procedures. Please review carefully before your procedure date.

⬇   Download NPO Guidelines
All Patients

Fees for Forms & Letters

Our fee schedule for disability paperwork, leave certifications, and other administrative documents we complete on your behalf.

⬇   Download Fee Schedule
All Patients

Records Release Authorization

Use this form to have your Coastal Spine & Pain records sent to another provider, an attorney, an insurer, or yourself. Please read Section 9 regarding care you received before July 1, 2026.

⬇   Download Records Release Form
Provider Offices

Records Request Form

One-page request form for physician offices and health information management departments. Fax completed requests to (888) 894-5212.

⬇   Download Records Request Form

What to Bring to Your Appointment

In addition to your completed paperwork, please bring the following to your appointment:

  • Valid government-issued photo ID (driver’s license, state ID, or passport)
  • Insurance card(s) — primary and secondary, if applicable
  • Referral or authorization from your primary care physician, if required by your plan
  • Any relevant imaging (MRI, CT, X-ray) on CD or via digital transfer
  • A complete list of current medications, including dosages
  • Copay or co-insurance payment (we accept cash, personal checks, all major credit and debit cards, and HSA or FSA cards)