New Patients

Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Please printout and complete the appropriate forms:

note: The above documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.


Patients wishing to make an appointment may contact Interventional Spine & Sports Medicine PC at 203-598-PAIN (7246) or by email . To aid in making your first visit more time efficient, we provide our initial in-take forms for your convenience. Please download these forms, fill them out fully and bring them with you at the time of your appointment. It is also important for you to be complete with your medical history particularly as it applies to your spinal problem. Please bring any imaging studies including all x-rays and MRIs of your spine.

Middlebury Office
Turnpike Office Park
1579 Straits Turnpike
Middlebury, CT 06762

Prospect Office
Pond Place
166 Waterbury Rd, Suite 204
Prospect, CT 06712

Farmington Office
399 Farmington Ave,
Lower Level
Farmington, CT 06302

How to Get Ready for Your First Appointment

  • Bring all related medical records and original diagnostic films (X-rays, MRI, etc.)
  • Check your insurance plan with the insurance page to verify coverage.
  • Bring a valid insurance card and driver’s license.
  • Bring list of your current medications.
  • Bring the referral from your primary care physician, if required

Footer Address


1579 Straits Turnpike, Middlebury, CT 06762

166 Waterbury Rd, Suite 204 Prospect, CT 06712

10 Birdseye Road, Suite 200 Farmington, CT 06032

1952 Whitney Ave, 1st Floor Hamden, CT 06517



203-598-PAIN (7246)

Fax: (203) 598-0200