New Patient Forms

Experienced Care To Relieve Your Pain

To save time during your initial visit with Dr. Roth, please take a moment to download, print, and fill out the new patient forms below. Please bring the completed forms with you to your appointment – we can’t wait to meet you!

(Please click on the picture below to view the PDF)

New Patient Intake Form

Paincur Consent Form

Paincur Evaluation Form

Paincur Guarantee Form

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