Patient Forms

Completing the proper medical forms, is necessary during your initial consultation with pain management New York specialist Dr. Melepura. Below, you may find links to our Patient Forms you may simply click on the desired form, print the form, complete each field, and bring these forms with you on the day of your scheduled appointment. We look forward to meeting you when you visit New York pain specialist Dr. Melepura.

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In addition to bringing these completed forms to your initial appointment, also bring:

• Any pertinent Medical Records, including any previous (if any) xrays and reports you may have had done
• A list of current medications
• Insurance Cards
• Co-Payment – if your insurance company requires one, we are required by them to collect this payment at the time of service – You may pay by Visa/Mastercard credit or debit card or check

Febin Melepura, MD is a top rated, best in class interventional pain management doctor. He is a nationally recognized pain relief specialist and is among the top pain care doctors in New York City and the country. He is an award winning expert and contributor to a prominent media outlets.

Dr. Febin Melepura has been recognized for his thoughtful, thorough, modern approach to treating chronic pain and, among other accolades, has been named a “top pain management doctor in New York”, and one of “America’s Top Doctors™” for an advanced sports injury treatments.