Thepaincenterus.com

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The Pain Center of Virginia, West Virginia and Maryland

WebPlease call (304) 263-6165 or referrals may be faxed to (304) 263-6536. Contact Us. Dr. Baksh has a policy regarding the prescribing of controlled substances, and every patient …

Actived: 8 days ago

URL: https://thepaincenterus.com/

Virginia Pain Management Clinic

Web1839 West Plaza Drive. Winchester, Virginia 22601. Phone: (540) 773-2689. Fax: (540) 486-4166. Monday – Friday: 8:00 am – 4:00 pm. Saturday & Sunday: Closed. Get Directions. …

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HIPPA INFORMATION AND CONSENT FORM

WebHIPAA INFORMATION AND CONSENT FORM . The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy.

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Please circle all CURRENT symptoms

Web1839 W. Plaza Drive Phone (340) 773-2689 Winchester. VA 22601 Fax (540) 486-4166 Suite 300 (304) 263-6165 WV 25401 Fax (304) 263-6536 THE PAIN CENTER

Category:  Health Go Health

AUTHORIZATION TO RELEASE MEDICAL RECORDS

WebAUTHORIZATION TO RELEASE MEDICAL RECORDS Patient Name: _____ DOB: _____Phone:_____ Patient’s Address: _____

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Please circle all CURRENT symptoms

WebPatient Name: _____ Please circle all CURRENT symptoms General Health All Normal Lack of energy

Category:  Health Go Health

AUTHORIZATION TO RELEASE MEDICAL RECORDS

WebAUTHORIZATION TO RELEASE MEDICAL RECORDS Patient Name:_____ DOB:_____SSN:_____ Patient’s Address:_____

Category:  Medical Go Health

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