For Patients

Thank you for considering us to be part of your health care team. We are dedicated to providing you with outstanding health care and are committed to treating you with the utmost respect. Please return the completed New Patient Registration Kit by mail or in person to 2002 Orange Road, Suite #201 Culpeper, VA 22701, via email to info@mypaincenter.org, or via fax at (540) 738-0105.

Also, please familiarize yourself with the Notice of Privacy Practices. This Notice of Privacy Practices explains how your protected health information may be used. Additional forms are located here for your convenience should they be required during the course of your care.

.New Patient Registration Kit

Consent for Release of PHI: Use this form if you wish for another person such as a family member or an organization to have access to your health information

Authorization for release of medical information: Use this form if you wish for our office to send your medical records to another office

HIPPA Privacy Rule Summary

HIPAA Privacy Rule