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903A South Greeley Highway, Cheyenne, WY 82007 COMPLIANCE CONTRACT It is our goal at Pain Consultant of the Rockies to take a multidisciplinary approach when treating chronic pain. We aim to treat the mind and the body using multiple therapies and agencies. Therefore, we will likely be referring you to physical therapy and/or psychological services. Upon referral, we ask that you seek the first available appointment with these providers. Since these therapies play a very important role in your pain management program, attendance is monitored. Please note that appointments are at a premium with Pain Consultants of the Rockies and these outside providers. Therefore, we ask that you give 24 hours notice should you need to cancel and appointment. A self-addressed courtesy reminder card will be mailed during the week before your scheduled appointment. A total of 3 successive no shows with any provider will prompt a re-evaluation of your commitment to this program and could possibly result in dismissal from the practice. Exceptions may be made in extreme circumstances. We aim to give our patients our undivided attention during their scheduled appointments. Therefore, we cannot accommodate patients without an appointment while we are in clinic. Walk-in appointments are not available. Should you have a question or concern please feel free to call our office and leave a message. Your call will be returned as quickly as possible and in order of severity. Messages received after 3:00 pm will be returned on the next business day. Please refrain from leaving multiple messages regarding the same issue. Our office requires 5 business days to complete forms that will be filled out by a qualified staff member. Please note that a fee is charged for each form to be completed. However, there will be no charge for Government Disability Forms. Please plan accordingly, as there are no exceptions. Lastly, we at Pain Consultants of the Rockies have adopted a Zero Tolerance policy with regard to abuse in the workplace. At no time will foul or abusive language or behavior directed toward our staff be tolerated. These actions are grounds for immediate dismissal from our practice. Your signature indicates you understand this contract and agree to abide by it.
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