SXM   SYMPTOM MEDICINE

Pain Medicine, Palliative Care, Anesthesia


2030 north pacific ave., suite f, santa cruz, ca 95060

tel. 888.796.6331  fax 888.796.6330

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FOR PROVIDERS
        Medical Services
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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.

PATIENT FORMS & CONTRACTS

  1.     Allergy & Medication Update List

  2.     SxM ANTI-COAGULANT POLICY

  3.     Concierge Request

  4.     SxM CONSENT FOR PROCEDURE & ANESTHESIA

  5.     SxM CONTRACTED INSURANCE COMPANIES

  6.     SxM CONSULTATION REFERRAL FORM

  7.     SXM CONTROLLED SUBSTANCE EDUCATION  

  8.     SXM CLINIC PARTICIPATION

  9.     Follow-up Clinic Appointment Form

  10.     SXM OPIOID CONTRACT

  11.     SxM PAIN FORM

  12.     SxM PAYMENT OPTIONS

  13.     PAR DEA

  14.     Quarterly Clinic Follow-up Form

  15.     SxM PATIENT FINANCIAL RESPONSIBILITY

  16.     SxM PATIENT SURVEY

  17.     SxM PATIENT REGISTRATION

  18.     SxM RELEASE OF INFORMATION

  19.     SxM TERMS & CONDITIONS OF SERVICE   

  20.     Self Determination Forms (POLST, DNR/DNI, DPOA)

  21.     SxM 30 DAY NOTICE OF DISCHARGE