Fast-Track Patients

Download and complete this package:

  1. Fast-Track Package
  2. Enrollment Checklist
  3. Printable Directions

Patient Forms

New Patients

Download and complete this package:

  1. New Patient Application Package
  2. New Patient Questionnaire (Spanish Version / Verción en Español)
  3. Enrollment Checklist
  4. Printable Directions
  5. Financial Policy Agreement
  6. Appointment Policy Form

F. A. Naveira, MD


Call Us:  (336) 223-8333

Medication Management

Be advised that not all clients qualify for this. As a rule, we do not take patients exclusively for medication management. This type of treatment is occasionally used in support of our minimally invasive pain management program.
  1. Initial NCPMS Screening Test
  2. Opioid Pain Medication Informed Consent
  3. Opioid Medication Agreement

Established Patients

Download and complete the applicable Forms:

  1. Chronic Opioid Use Assessment Tool
  2. Pain Diary
  3. Request for uncovered services