Pain Center Admission Forms
For your convenience and in order to expedite the admission process, we ask that you download the forms listed below, fill them out completely, and bring with you on your first appointment date.
Interventional Pain Management
If your assigned physician includes:
Dr. Laura Audell, Dr. Jana Baumgarten, Dr. Azita Far, Dr. Viliam Furdik, Dr. Leticia Lau, Dr. Yong-Jian Lin, Dr. Cynthia Mathis, Dr. Kenith Paresa, Dr. Gary Rosengarten, Dr. Howard Rosner, Dr. David Scott, or Dr. Christopher Zarembinski
Please complete and bring the following forms with you.
Headache, Orofacial Pain and Sleep Apnea Program
If your assigned physician is either Dr. Steven Graff-Radford, Dr. Alan Newman or Dr. Katayoun Omrani, please complete and bring the following forms with you.
The forms below should be substituted for the Head and Neck Evaluation Form if you are being seen for either of the following conditions:
- If you are experiencing sleeping problems, please complete the Sleep Evaluation Form
- If you are experiencing numbness, please complete the Numbness Evaluation Form.
If you are scheduled for a procedure, you may download instructions preparing you for sedation by clicking on the icon below. This material should be read a minimum of six days prior to your procedure. You may also call (310) 423-9857 for an automated message outlining the same information. Procedures, Medicines and Instructions.