CPM New Patient Referal Requirements:
Patients MUST have a referral from their primary care physician or other doctors that they see on a regular basis.
- Referrals can be faxed to (833) 450-5933
- The inclusion of recent applicable imaging reports is preferred.
CPM Medical Records Requests:
In order to receive your medical records please select the Release of Information Form under CPM Forms and fill out the applicable information. You may fax this form to 833-450-5933, bring it into the clinic, or mail it into our office. Please be aware that your request may take up to five business days to process depending on volume. The following is our medical records associated fees:
$30 for greater than 20 pages
$0.50 per page from 21-50 pages
$0.25 per additional page after 50 pages
Statute ORS 192.521
CPM Patient Forms:
Corvallis Pain Management patients can now download their required forms below.
- Welcome Letter For New Patients
- New Patient Packet part 1
- New Patient Packed part 2
- Patient Information
- Patient Health Questionnaire
- Opioid Agreement
- Owestry Disability Questionnaire
- Release of Information Form
- Limited Disclosure Authorization
- Privacy Practices
- Receipt of Notice
- Pre-Procedure Instructions
- Financial Policy
- Patient Email and Text Messaging Registration Form
CPM Late Policy:
NOTICE: Due to our high volume of patients, NEW PATIENTS need to arrive at least 30 minutes early to their appointment. If a new patient arrives after this time there is a possibility that they MIGHT NOT be seen. FOLLOW-UP PATIENTS need to arrive at least 15 minutes early to complete necessary paperwork. Patients who are FIVE MINUTES late to appointments will be rescheduled.
At Corvallis Pain Management, it is our goal to provide quality, individualized medical care in a timely manner. No shows and late or repeated cancellations inconvenience those individuals who need access to medical care in a timely manner. We would like to remind you of our office policy regarding missed appointments. This policy enables our clinic to better utilize available appointments for our patients in need of urgent medical care. We understand that things crop up in people’s lives that are unexpected and while we truly are sympathetic, in fairness to all patients, this policy is in effect regardless for the reason of cancellation.
Not receiving a reminder is NOT an acceptable excuse for missing an appointment. These reminders are a courtesy to keep you on track with your schedule and should not be relied upon as your sole method of knowing when your appointment is.
Tardy Policy:
As you can imagine, late arrivals can set back our schedules significantly both for the clinic and for all patients. As a courtesy to our patients, if you arrive 5 minutes late you will be asked to reschedule and your appointment will be recorded in our system as a cancellation. The choice to accomodate for the change is at the provider’s discretion. More than 3 tardies, is grounds for dismissal from the clinic.
Cancellation Policy:
If it is necessary to cancel your scheduled office appointment, we require that you give at least 24 hours notice. Available appointments are in high demand and your early cancellation will give another patient the possibility to have access to timely medical care. 3 cancellations in a row or greater than 5 overall cancellations is grounds for dismissal from the clinic.
No-Show/Late Cancellation Policy:
A no-show is someone who misses an appointment without cancelling it in an adequate manner. Failure to be present at the time of a scheduled appointment will be recorded in our system as a no-show. No-shows are subject to a $100 fee for procedures, $40 fee for in-office injections (without fluoroscopy), and $30 for follow-ups. If we do not receive at least 24 hours notice of cancellation, the appointment will be marked as a late cancellation. A total of 3 no shows/late cancellations is grounds for dismissal from the clinic.
We also offer procedures at Waverly Lake Surgery Center. Please visit their site to fill out pre-op paperwork online.
