Southeast Regional
Pain Center

Call to book


Welcome!  All new patients must complete the forms below prior to their first appointment.  Simply click to download and print the PDFs, fill them out, and bring them with you at your first appointment or first visit. 

Beck Inventory

Conset to Communication

General Consent Form​

General Substance Abuse

Initial Pain Assessment

McGill Pain

Medical History

No Show Policy

Notice of Privacy Practices

Patient Information

Patient policies

Informed consent and agreement for Opioid Therapy of Pain

To become a patient of Southeast Regional Pain Center, please have your Primary Care Physician or Specialist Physician fax the following information to (706) 571-8820

  • Patient Demographic Information
  • 3 Office Visit Notes
  • Imaging reports relative to pain diagnosis
  • Laboratory reports relative to pain diagnosis
  • Front and Back copy of health insurance card(s)
  • Surgical Reports relative to pain diagnosis
  • If prior history with pain management office:
    • office notes required
    • letter of dismissal is required

Fax Number: 706-571-8820

Please note, we do not accept self-referrals and are not able to accept records provided by patients. All referrals and records must come from a licensed physician or hospital entity.

Thank you!  If you have any questions please contact our office at (706) 571-7246