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New Patient Form

Download the new patient intake to complete prior to your first visit.
Home » New Patient Form

Click the button below to download our new patient intake form. Once the file is downloaded, double-click the file and let your PC or MAC open the file for you. If the file does not open correctly, you may need to install Adobe Reader.

Once the file is open, print out the form and fill it our prior to your first visit.

 

patient-intake-cta

 


I moved to Phoenix recently from the Midwest, and found Premier Pain Solution on the web. And am I glad I did. They got me in quick, treated me with kid gloves, and my pain is over 50% less when I started. Great pain center. Dr Moore is very thorough.
– Vernon

A friend told me about their free massage, so I went for that and it was awesome:) I got to meet Dr. Moore who talked to me about my back pain, since then I’ve d one 2 weeks of therapy and its much much better. Very friendly staff too.
– Lindsey

A friend from work recommended the practice. I was in a car accident 3 years ago and my back goes out every few months. The decompression helped a lot and the Chiropractor adjusted me and I received pain management and my pain is gone and the massages are awesome!
– Lisa

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