Forms

Denver Back Pain Specialists welcomes you to our practice!

Dear New Patient

Please complete these forms before your first visit:

Patient Information Form

Spine Health History

Payment Policy

Privacy Policy

Online Communications Informed Consent

Confidential Communications Request

Medical Release Form

In some cases, you may also be asked to fill out these function related questionnaires:

Modified Oswestry Low Back Disability Index

Modified Oswestry Neck Disability Index

For referrals to Physical Therapy:

Physical Therapy Referral: Denver Back Pain Specialists

For referrals to Dr. Bainbridge and Dr. Trainor:

Referral Form: Denver Back Pain Specialists

Additional Practice Information and Disclosures:

Notice of Physician Business Relationships

Injection Information and Forms

 We accept, and are “in-network” with, the following insurances:

Aetna

Ameriben

Auto

Beech Street

BCBS

Cigna/Great West

CNIC

Cofinity

Cover Colorado/Rocky Mountain Health Plans

First Health

GEHA

Golden Rule

Humana

Medicare

Pinnacol (SelectNet)

San Luis Valley

Unicare

United Healthcare

Secure Horizons

Tricare ( not prime )

Work Comp