Your physician has referred you to Dayton Pain Center to be
evaluated and to see what type of pain management treatment would be best suited for you. After
receiving the referral from your physician, our staff contacts you to schedule your first visit. Our
goal is to help you manage and cope with your pain so that you may become more functional in your daily
activities. In order to best serve you, we must learn as much about you, your painful condition, and how
it affects your relationships with family, friends, and employment etc. We have found that all of this
information is necessary if we are to provide the best possible diagnosis and treatment plan for you. It
will be very helpful to forward any records of previous pain management to us. Bring any pertinent X-ray
reports and list of current medications on your first visit.
It is important that you take the time to complete the 'Initial History form with Pain Questionnaire,
the Patient Demographic form, and the Patient Privacy Policy' before you come for your first visit.
These forms are available for you by mail or by Internet download.