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You must print and complete the following forms to bring with you on your first visit.

Print this form first: Welcome information and checklist
 

Effective February 1, 2004 - If you do not come to your New Patient Appointment and do not call to cancel, a fee of $25.00 must be paid before another appointment will be made for you.

Surgery Scheduling Sheet Narcotic Informed Consent Compliance Contract Family Release of Information Insurance Agreement

Voice Mail Authorization Demographics Sheet Patient Appointment Card Privacy Practices

Handouts for your information.

All of the procedures described below are performed by Dr. Ribnik in an outpatient clinic. All are performed under sterile conditions with constant monitoring devices and x-ray guidance is used for each procedure. Pre-and postoperative care will be given by his professional staff. Each procedure does require an informed consent to be signed. IV sedation is available if someone is available to drive the patient home. Each patient is contacted 5-7 days after their procedure to monitor their progress and to check on complications, and a return to clinic appointment is scheduled for 7-14 days.
 

Patient Handbook Medial Branch Nerve Blocks Stellate Ganglion Bretylium Bier Blocks Facet Joint Injections Intrathecal Pump Therapy Neuro or Spinal Stimulation

Medications Epidural Steroid Injection Lumbar Sympathetic Block Transforaminal Epidural Steroid Injections Intradiscal Electrothermal Therapy or IDET Nucleoplasty

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