If you are a new Pain Management Patient please click on the below links to complete necessary forms and assessments. Your first visit can only be scheduled after we analyze the completed paperwork.
First we need information on your history and experiences. We ask that you prepare to complete these forms in a secure and private place. We would also ask that you and only you answer these questions as openly and as honestly as possible. If you require assistance with completing the forms, assistance from others is fine, but no coaching should occur during that assistance.
HIPAA Notices of Policies and Practices is included and you can be assured that your privacy regarding this information is of utmost importance to us. In compliance with HIPAA, the only people who will have access to this information are Dr. Douglas Cox, PH.D., your insurance provider (who requested your visit), and the referring physician.
If at any time you are unsure as to how to complete the forms, please call Melody at 865-382-7256 and she will talk you through it.
We appreciate your diligence in completing theses forms and assessments as soon as possible, and let us know if you have any issues at all.
As soon as you submit any information, it is immediately stored in a secure database. Caution – If you leave the page before submitting the form, your data will be lost, because we can not keep your information in the memory of this website.
Step 1 – Complete personal and insurance information form.
Step 2 – Complete Epidemiologic Studies Scale.
Step 3- Complete Childhood Experience questionnaire.
Step 4 – Complete the two online Pearson Assessments (2 e-mails with links to Pearson’s website will be sent to the e-mail address you provided our office.)
Step 5 – Five minutes before your scheduled appointment time click on the following link to be connected to Dr. Cox’s online waiting room. (If the Doxy.me link is not supported in your browser, your visit will be conducted through Apple FaceTime or on a phone call.