Patient Questionnaire
Complete this four-page fillable questionnaire before your appointment.
Patient Resources
Patient Forms
Review and complete the forms requested by your care team before your visit.
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Prescription Policy
Review spineTECH’s policy for prescription requests and medication-related questions.
HIPAA Release of Information
Use this form when spineTECH asks you to authorize the release or sharing of health information.
Consent for Care and Treatment
Review and complete this consent form when requested by your care team.
Out-of-Network Provider Notice
Review this notice when your care team tells you that an out-of-network provider may be involved. Formal document title: “Member Advance Notice Form for the Involvement of a Non-Participating Provider.”
Out-of-Network Referral Authorization
Complete this form only when your care team asks you to authorize a referral to an out-of-network physician. Formal document title: “Disclosure and Authorization Form for Patient Referral to Other Non-Participating Physicians.”