Pain Consultants of the Rockies, PC
and Pain Treatment Center of Wyoming, LLC

903A South Greeley Highway, Cheyenne, WY  82007
307-633-8100  Fax: 307-633-8108 


Hello and welcome to Pain Consultants of the Rockies.
 

You are receiving this letter to acquaint you with some of the tasks that we require you complete prior to your first appointment with Dr. Harlan Ribnik on:_____________________________.
 

IT IS NECESSARY THAT YOU COMPLETE THE FOLLOWING TASKS PRIOR TO YOUR FIRST APPOINTMENT OR IT MAY BE NECESSARY TO RESCHEDULE YOU TO A LATER DATE. 
PLEASE USE THIS WORKSHEET SO NOTHING IS INADVERTENTLY FORGOTTEN. THANK YOU!

1.    Call all doctors you have seen over the past year and request that your medical records be 

       sent or faxed to the following:
 

 903A South Greeley Highway, Cheyenne, WY  82007
Attn:  Medical Records
OR
FAX:  307-633-8108
 

Check here when completed:

 


 

2.    Arrange to pick up all radiographic films (xrays, MRIs, CTs, etc.) you have had taken over the 

       past 2 years.  You MUST hand carry these to your appointment.  Films from out-of-state can

       be mailed by the facility at which they were taken provided the Radiology Department there

       is given adequate notice.  If you have difficulty obtaining films from out-of-state, please call

       our office as we may be able to assist you.
 

Check here when completed:

 


 

       Please bring the bottles containing ALL medications you are currently taking, including

       those that are “over the counter”.  This will help us to complete your medication list.
 

Check here when completed:

 


PLEASE PLAN ON ARRIVING ONE HOUR BEFORE YOUR SCHEDULED APPOINTMENT TIME TO COMPLETE THE “NEW PATIENT PACKET”. 

THE INFORMATION IN THIS PACKET ASSISTS DR. RIBNIK IN HIS EVALUATION OF YOUR CONDITION AND IN THE FORMING OF YOUR TREATMENT PLAN.  THEREFORE, IF THE INFORMATION IS NOT COMPLETE, WE WILL NEED TO RESCHEDULE YOUR APPOINTMENT DATE AND TIME.

We thank you for your cooperation and, again, welcome to

Pain Consultants of the Rockies!

 

 

 

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