Northwest Plain Care, Inc.

421 W. Riverside Ave., Suite 900, Spokane, WA 99201

New patients please download, print and complete the following form before you arrive at our office.

 

    • New Patient Intake Form [Word file, 686Kb]

 

Existing patients, please download, print and complete the appropriate follow-up visit form, as instructed.

 

Please complete the following forms, if instructed

 

   • Pain Medicine Referral Request [Adobe PDF, 82Kb]

   • NWPC Notice of HIPAA Privacy Practices[Adobe]PDF116Kb]

   • HIPAA Privacy Authorization Form

   • Cervical Disabilty

   • Lumbar Disability

   • Opioid Risk Tool

   • ROI

 

 

 

 

Ask your primary care physician how Northwest Pain Care can help you get back to the life you enjoy. Upon receipt of a referral from your physician, our providers and staff will contact you about scheduling an appointment.

Northwest Pain Care

421 W. Riverside Ave., Suite 900, Spokane, WA 99201

Address

Tel: 509-863-9789/Fax: 855-630-0757

Forms

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