Capital Region Special Surgery medical office Albany, NY

A multi-disciplinary practice dedicated to state-of-the-art care.

Medical specialists Albany New York

Pain Management Patient Forms

New patients are asked to complete several important questionnaire forms. This information is required to assure you will receive the best medical care.  These forms are available below (Adobe Acrobat format-PDF) to print and complete prior to coming in for your first appointment.  This will speed up the time you will spend in the waiting room for your appointment. Thank You

New Patient Intake
Patient Intake Medical
Face Sheet
HIPAA Statement
Insurance Guarantee
Office Policies
Records Release Form
Opiate Pain Management Contract
Workers Compensation Information Form

For established patients, we also offer a secure, encrypted patient portal that provides an efficient alternative to phone calls and office visits when you have non-urgent healthcare needs: Request or Cancel Doctor Appointments; Request Medication Refills; Send a Note to Your Provider.  Call our office for information on how to activate your account.

To our patients and referring providers:

In light of the recent cases of fungal meningitis from methylprednisolone used for epidural steroid injections, we would like to provide some important information.  

The physicians of Capital Region Neurosurgery and Pain Management have never used any products from New England Compounding Center in Framingham, Massachusetts, which is the only compounding pharmacy linked to the fungal meningitis outbreak.

It is important to note that millions of people a year receive epidural steroid injections safely and with excellent results in their neck, back, knees and shoulders.

Our highly skilled team of physicians focuses on outstanding care with safety our number one priority.

If you have any additional questions, please do not hesitate to call us.


Fields marked with an * are required

If this is an emergency or life-threatening situation, please call 911. Questions related to surgery scheduling, cancellation, rescheduling or pre-operative exams must be conducted via telephone or in-person with our surgical scheduling staff during normal business hours.

Have you had any of the following imaging studies done as they pertain to your requested appointment?