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Patient forms

New patient forms.

Filling these out ahead of your appointment helps us get started faster. Bring printed copies, or we will provide them at check-in.

Coming soon

New Patient Intake

Background, current symptoms, prior treatment, and goals for the first visit.

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Coming soon

Medical History Questionnaire

Past medical and surgical history, current medications, and allergies.

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Coming soon

HIPAA Authorization

Authorize how your protected health information may be shared during care coordination.

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Coming soon

Insurance Verification

Insurance details, member ID, and policyholder information so we can verify benefits before the visit.

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Coming soon

Records Release

Authorize release of prior imaging or specialist records to support evaluation.

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Bring printed copies to your appointment, or we will provide them at check-in. Need help? Call us at 713.369.1969.

Before your visit

New patient forms & what to bring

Completing your new-patient paperwork before you arrive helps Dr. Rehan Memon's team verify your benefits, review your history, and start your evaluation on time. Here is what to finish in advance and what to bring to your visit at our Pasadena, Baytown, or Katy office.

What to complete before your first visit

Finishing a few standard forms ahead of time keeps your appointment focused on your pain, not paperwork. The new-patient intake form collects your contact details, pharmacy, and the reason for your visit. A medical history form asks about past diagnoses, surgeries, current medications, allergies, and prior pain treatments, so Dr. Memon can plan an appropriate, non-surgical approach.

You will also review a HIPAA notice and consent, which explains how your protected health information is used and kept private. Insurance verification lets our team confirm your coverage and any copay before you arrive; we verify benefits with insurers such as Medicare, UnitedHealthcare, BCBS, WellMed, Wellcare, Molina, and Cigna. A records release authorizes us to request relevant notes or imaging from your prior providers. Completing these in advance helps prevent delays and surprises on the day of your visit.

What to bring to your appointment

Bring a valid photo ID and your current insurance card so the front desk can confirm your identity and coverage. Bring a written list of your medications, including doses and how often you take them, plus any drug allergies. This helps Dr. Memon evaluate your pain safely and avoid interactions.

If you have had recent imaging, bring the MRI, CT, or X-ray report and, if possible, a disc or access link, along with related specialist or hospital records. Bring your referral from your primary care or treating provider as well. Our bilingual (English and Spanish) staff can help if you have questions about any document when you arrive.

Frequently asked questions

How early should I arrive?

Please arrive about 15 minutes before your scheduled time so the front desk can confirm your ID, insurance, and forms. If you completed your intake paperwork in advance, check-in is usually quick, leaving more time for your evaluation with Dr. Memon.

Can I fill out forms in Spanish?

Yes. Our staff is bilingual in English and Spanish and can help you understand and complete your intake, history, and consent forms. If you prefer assistance in Spanish, simply let us know when you call or arrive, and a team member will help you.

What if I don't have my imaging?

You can still keep your appointment. With a signed records release, our team can request relevant MRI, CT, or X-ray reports from your prior provider. Bringing whatever reports or contact information you have speeds this up, but missing imaging will not stop your visit.

Appointment request

Ready to start feeling better?

Tell us where the pain is affecting your life and which clinic is easiest for you. We will reach out to confirm availability and next steps.

Referral required for all new patients
Benefit verification before your visit
Fast scheduling across all three clinics
Call 713.369.1969

Request an appointment

Share your details and preferred clinic. We will confirm the next available appointment options.

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