The following forms have been provided to you in an attempt to help assist in your transition from another pain clinic, oncoming as a new patient or simply to release or obtain records as a current patient.The forms are in PDF format – simply click the form that you require and the download will begin. From that point you should be able to open your downloads folder and print them.


Authorization to Discuss/Share Medical Records/HIE Form

Authorization to Discuss or
Disclose Health Information

Adobe Acrobat document [391.7 KB]

Authorization to Release Records from Georgia Pain and Spine Care

Auth to Release Med. Rec.
to different Facility

Adobe Acrobat document [82.7 KB]

Authorization to Release Records to Georgia Pain and Spine Care

Authorization to
Release Medical Records

Adobe Acrobat document [80.4 KB]

Physician’s Office Fax Referral Sheet

Fax Referral Sheet

Adobe Acrobat document [628.5 KB]