Welcome to Boston PainCare Center!

As part of our comprehensive new patient assessment, we require medical history in order complete a thorough assessment. Please print the forms below at your convenience by clicking on each link. Complete each form and bring the completed forms to your scheduled appointment. New patients are also required to bring valid photo identification, valid insurance card(s) and copies of all related imaging reports. Additionally, it is the patient’s responsibility to obtain an insurance referral from the Primary Care Physician (PCP).

If you should have any questions, please contact (781) 647-PAIN (7246) to speak with a Patient Care Coordinator who will be able to assist you.

For New Patients...

Patient Demographic Form

New Patient Health History Form

Consent to Treat Form

Epworth Sleepiness Scale Form

Health Status Questionnaire

Medical Records...

If you are requesting your medical records, please print the Authorization for Use or Disclosure of Health Information form at your convenience by clicking on the link. Complete the Authorization for Use or Disclosure of Health Information form and fax form to (781) 290-0720. If you should have any questions, please contact (781) 647-PAIN (7246) to speak with a Patient Care Coordinator who will be able to assist you.

Authorization for Use or Disclosure of Health Information

If you are a new SleepCare Patient, please click here for a list of forms to download and fill out.