I rvine Regional Pain Center Dr. Babar Iqbal 949-748-3713 The mission of Irvine Regional Pain Center is to provide quality safe and accessible care, decreasing pain and increasing function, through a multi-disciplinary approach to pain management. The purpose of this form is to provide general information regarding our expectations of patient in order to assist in the success of treatment plans. 1. Patients are seen by appointment only. Walk-in evaluations are not provided. 2. Please call the Pain Center at least 24 hours in advance if you are unable to keep your scheduled appointment. 3. Patients who miss 3 scheduled appointments without adequate prior notification can be dismissed from the practice at the prerogative of the physician. 4. Please make every effort to arrive on time for appointments. 5. Please understand that chronic pain is different from acute pain. There is no "immediate" relief from chronic pain. It may require several treatments to begin to address chronic pain and its related issues. 6. The physician may choose not to provide prescriptions for any medications including opioids (narcotics). If pain medication is clearly indicated, the physician will make appropriate recommendations to your primary care physician. 7. Unless there is prior agreement between the referring doctor and the Pain Center physician, controlled substance-including opioid narcotics-will typically not be provided at the time of the initial evaluation. 8. Pain treatment typically requires a multi-disciplinary approach that utilizes a combination of treatments. Please comply with all treatments that have been agreed upon between you and your physician. 9. Our goal is to work with you to improve your overall quality of life and functional abilities. This requires that you are an active participant in the treatments designed to decrease pain and increase function. I have read and understand the above policy. ____________________________________ Patient Signature _____________ Date Pharmacy Information Name of Pharmacy:_____________________________________________________________ Address:_____________________________________ Phone #: ________________________ IRPC-105