Patient resources

Office Hours
For information or to schedule an appointment, please call us at phone number408-528-8833.
Monday-Friday: (9:00am – 5:00pm)

Preparing for a Clinic Visit
If you are a new patient, to best utilize time, you are encouraged to bring these enclosed forms completed with you to your appointment.

What to bring with you to your Appointment

  • Picture ID
  • All Insurance Information
  • Required Referral Information or Letters as necessary
  • Any required Deductible / Co-Payments

Item to note before your Appointment

  • Having the appropriate forms filled out before your visit will reduce your total visit time.
  • Please allow for time to park; parking availability varies with each clinic location.
  • Clinic registration is done by appointment time. To decrease your overall waiting time, we recommend that you do not arrive more than 20 minutes prior to your appointment.

Cancellation Policy
If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours’ notice. This courtesy, on your part, will make it possible to give your appointment to another patient. There is a $75 cancellation fee for patients who miss appointment or do not provide 24-hour notice.

At Allied Pain Institute, we believe that all insurance plans should be treated equal. Our roster of insurance plans and options is comprehensive. We accept Medicare, Worker’s Compensation, most HMOs, most PPOs, and many Liens. Every patient, regardless of their insurance type, receives the same efficient, effective and friendly service and medical care.

Payment Options

For your convenience, we accept cash, check, Visa, Master Card and American Express.


Patient Forms
The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit.

New Patient Consent Form – Patient Resources
Medical Intake Form – Patient Resources
Release of Records Authorization – Patient Resources

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.