New Patients //

How to Request a New Patient Evaluation (3 Steps):

1. Please fill out the "New Patient Form"  below so that we may create an online portal and also check your insurance eligibility. Once we have reviewed the submitted information, we will send you a "Welcome" email from appointment@webMDpain.com that states that your ProCheckIn account has been created. 

New Patient Form

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INSURANCE Information (At this time, we do not accept Medicaid)

Primary Insurance Carrier

Please Upload picture of the Primary insurance card if available. 

Upload File

Secondary Insurance Carrier (If applicable)

Please Upload picture of the Secondary insurance card if available. 

Upload File

Please keep in mind that communications via email over the internet are not 100% secure. Although it is unlikely, there is a possibility that the information you include in this form and in an email can be intercepted and read by other parties besides the person to whom it is addressed. Our online forms and email communication are encrypted and adhere to HIPAA Business Associate Agreement but we cannot guarantee absolute security of such information.

Please expect an email from appointment@webmdpain.com after we review your information. Thank you!

2. Once you receive a "Welcome" email from us confirming that your online ProCheckIn account has been created, please use the link below to log into ProCheckIn and fill out all paperwork under "New Patient" and sign all documents under "Legal Documents."

     https://pmi.prognocis.com/prognocis/pmiProCheckIn.html

3. Once all the paperwork and documents have been submitted, please reply to the "Welcome" email and state that the forms have been completed. We will review and call you on your phone to schedule the appointment.