Before your first visit to Queens Pain Clinic in Rego Park, you can download, fill out and send us your paperwork. Six forms are available. Send them by fax at least 24 hours ahead, hand them to our front desk, or register securely online.
Completing your paperwork at home lets your physician review your history before you arrive.
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Start with the two forms everyone needs, then add the ones that fit your situation.
Print each form, complete it at home, then fax it or bring it to your appointment.
Covers your medical history, current medications, prior treatments and a pain assessment. Set aside some time and keep your medication list handy.
Needed: your medication list
Lets our office release or receive your medical records and share your health information with the people you name.
Needed: names of people we may share with
Gives us permission to bill your insurance carrier directly.
Needed: your insurance card
For job injuries. Have your claim number, your employer's information and the date of injury before you start.
Needed: claim number, employer info, injury date
For no-fault and other motor vehicle accident cases. You will need your claim number, the accident date and the name of your auto insurance carrier.
Needed: claim number, accident date, carrier
Authorizes a previous provider to send your records to our clinic, so your physician has your full history.
Needed: previous provider details
Pick whichever is easiest for you.
Print, complete and fax everything at least 24 hours before your appointment. We will confirm receipt and prepare your file.
Call us for our fax number. 1-877-97 NO PAIN
Hand your finished forms to the front desk when you arrive. Plan to get here about 15 minutes early.
Use the secure registration form below. Someone from our team will contact you within one business day to confirm your appointment and answer questions.
Prefer to register online? Fill out this secure form and someone from our team will contact you within one business day to confirm your appointment and answer your questions.
The form asks for:
Queens Pain Clinic
9701 66th Ave, Rego Park, NY 11374
Phone: 1-877-97 NO PAIN
Our board-certified interventional pain specialists have treated patients in Queens since 2004. Not sure what to expect at your first appointment? Read our guide, and see how we handle billing.
Quick answers about patient forms and paperwork.
Yes. Every form is a PDF on this page. Print it, complete it at home, then fax it ahead or hand it to the front desk. You can also use online registration.
Every new patient completes the New Patient Intake Form and the HIPAA Authorization Form. Depending on your situation, you may need more: insurance billing, a work injury, a car accident, or records held by another provider each have their own form.
You can fax them, hand them to the front desk, or submit them through our secure online registration. Our team confirms receipt.
Yes. The Workers' Compensation Intake Form goes with your standard new patient paperwork. Have your claim number, your employer's name and the date of injury ready.
Use the Auto Injury Intake Form. It asks for the accident date, your claim number and your auto insurance carrier, which we need for no-fault billing.
Your contact and insurance details, family medical history, current medications and doses, past surgeries and treatments, and details about your pain: where it is, how severe it is on a 0 to 10 scale, how long you have had it, and what makes it better or worse.
At least 24 hours before your appointment, so our clinical team can review your history.
Yes. Your information is protected under HIPAA and is not shared without your written consent. Our online registration form encrypts what you submit.
Call 1-877-97 NO PAIN and our team will help you pick the right forms.
Last updated: October 2026. This page is for general information and is not medical advice. Results vary from person to person. See a qualified physician before starting any treatment.