SXM   SYMPTOM MEDICINE

Pain Medicine, Palliative Care, Anesthesia


2030 NORTH PACIFIC AVE., SUITE F, SANTA CRUZ, CA 95060

tel: 888.796.6331 fax 888.796.633

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FOR PATIENTS

        Become a Patient

        New Patient

        Current Patient

        Forms & Contracts

ADMINISTRATION

         Clinic Policies & Terms

         Finances & Insurance

         Patient Information    

         Make a Payment

RESOURCES

        Education & Library

        Patient Support

        Concierge Services

       

Patients will be required to read Clinic Policies and give an electronic signature to obtain any forms or reserve an appointment. This  website is not HIPPA secure; and thus, cannot accept or exchange ANY sensitive information or private data.

CURRENT PATIENTS                                         

For every follow-up appointment, you will need to complete the appropriate forms, have the ability to pay for any uncovered services, pay any outstanding balances, and obtain pre-authorization from your insurance carrier for any service.  Please, email, visit  or call our clinic for any additional information or to determine which forms are appropriate for you.


Please click on a form you needs, complete it, and fax or mail it to the clinic

  1.     Allergy & Medication Update List

  2.     Follow-up Clinic Appointment Form

  3.     Quarterly Clinic Follow-up Form

  4.     SxM ANTI-COAGULANT POLICY

  5.     PAR DEA

  6.     SxM PATIENT SURVEY

  7.     SxM CONSENT FOR PROCEDURE & ANESTHESIA

  8.     SXM OPIOID CONTRACT

  9.     SXM CONTROLLED SUBSTANCE EDUCATION

  10.     SxM RELEASE OF INFORMATION

  11.     SxM ANTI-COAGULANT POLICY

  12.     SxM PAYMENT OPTIONS