Welcome to Pain Specialty Group!

We look forward to providing you with personal, compassionate, and comprehensive care. Please read this form carefully and complete all requested information.

Many of our forms are written broadly for patients receiving pain management services. However, this paperwork also applies to patients receiving ketamine infusions and other treatments for depression, mood-related conditions, and mental health concerns. References in this form to pain treatment, pain management, or related services should be understood to include those treatments when applicable. Please complete the form according to the reason for your visit.

To ensure a secure and streamlined process, this form requires a valid email address. After submission, a separate e-signature link will be sent to your email. You must use that link to electronically review, verify, and certify the agreements made in this form. Although typing your name here serves as a preliminary signature, the follow-up e-signature is required for full legal verification and completion.

Our system is HIPAA compliant and prioritizes your privacy. For added security, verification, and authentication of your electronic signature, a Google account is required. If you do not have one, you can create one here: accounts.google.com/signup.

If you have any questions, please contact us at info@specialty.org or 603.383.2020.