Nerve Block Consent Forms
Consultation requests for patients with chronic pain
are referred to the Pain Control Clinic at the Ayers Medical Plaza for
scheduling of appointments. The consults and patient charts are then given
to the Pain Management fellows for work-up. If a diagnostic or therapeutic
nerve block is to be done, a Nerve Block Consent Form must be signed by the
patient and witnessed before administration of the block. Both the completed
consultation request and consent form should be returned immediately for
processing to the pain control secretary, who will arrange, if necessary,
for subsequent appointments and for immediate post procedural dispensation.
