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 

Voice Mail Authorization Form

Patient Name: ______________________ Social Security Number: ______________________
 

I hereby authorize the staff members at Pain Consultants of the Rockies, PC and The Pain Treatment Center of Wyoming, LLC to leave voice mail messages for me at my telephone number (s) of record or at any telephone number I may indicate in any message I leave.  I understand messages left by staff members could contain information which may be confidential in nature.

 _____________________________          ____________________
 Patient Signature                                                Date
 

 _____________________________          ____________________
 Witness Signature                                              Date

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