For Patients

Patients who have physician referral & are attending their first Salem Pain Clinic appointment must download, complete and bring along the new patient intake form below:

• New patient must bring valid medical insurance card to the appointment. 
• Patient must bring all current medications; or list of medications & dose.
• Patient attending for injection treatment should be accompanied by an adult.
• Patient must call the clinic to confirm an appointment one week before the date.
• Cancellation of appointment requires 72 hours notice, to avoid charges/fees.

Patients who want a 1st or 2nd follow-up appointment may book online. Salem Pain Clinic will confirm the appointment once we receive your form. Follow-up appointments may not always be possible.