Patient Forms
To save yourself time filling out forms at our office you can print and fill out all the following forms before your appointment and bring them with you. Remember to bring your insurance card and any X-rays, MRIs or other reports along with you, as well. Thank you again for choosing Louisiana Pain Care in Ruston and Monroe, Louisiana.
Please note: It may take a few minutes to load the forms if you are using a dial-up Internet Connection. If you are unable to view the forms, you may need to download Adobe Acrobat free by clicking on the icon below.
Financial Responsibilities:
Bring a copy of your insurance card to your initial appointment. Without insurance, a cash payment in full is required at the time of service. As a courtesy, we will file our insurance for you, but the patient is responsible for payment of all fees, regardless of insurance coverage or the status of any insurance claim(s). Louisiana Pain Care accepts most medical insurances, Workers’ Compensation Insurance and Medicare.
- Patients are financially responsible for all charges. We will bill Medicare or your primary and secondary insurance for you. Please be sure to bring your most current Medicare or insurance card with you.
- Be prepared to pay any deductibles or co-pays on the day of your appointment. Louisiana Pain Care accepts cash, cashier’s checks, credit cards and personal checks with valid I.D.
- Payment plans can be arranged for patients that do not have insurance coverage, or whose procedure is not covered by insurance.
- Financial arrangements must be made prior to your appointment. Please feel free to contact our business office at 318-323-6405 if you have questions or concerns.