Edgewood, Kentucky : Phone: (859) 331-4159
The Advanced Pain Treatment Center is committed to providing the highest quality, state-of-the-art and safe medical care to the pain patient. The center strives to reduce or eliminate pain when possible, and improve function and quality of life. For your convenience, the following forms are provided for your convenience in advance of your appointment with Dr. Gupta.

General Information about Procedures :

Since the Advanced Pain Treatment Center is an interventional pain management practice, most of the diagnosis is made or confirmed by interventional procedures. The procedures for treatment are performed under mild sedation so that patients are relaxed and able to cooperate during the procedure. Most of the time, the patients do not remember about the procedure. If the procedure is peformed for diagnostic reasons minimal to no sedation is administered. However all patients would typically have an intravenous line for safety purpose. Procedures are performed either to treat the disease or to diagnose a painful condition. A procedure could be both diagnostic as well as for treatment.

Patient Information & New Patient Forms

Please download the following the forms if you choose to complete patient forms at home prior of your initial appointment. Bring the completed forms to your appointment at the Center.

→ Notice of Privacy Practices

→ Background Questionnaire

→ Forms: Patient Consent

→ Forms: Patient Registration

→ Forms: Postprocedure Pain Diary

→ Forms: Preprocedure Check List

→ Forms: Release of Patient Medical Records

→ Post Facet Joint Diagnostic Block Form

→ Patient Information: Cervical Transforaminal

→ Patient Information: Lumbar Transforaminal Injection

→ Patient Information: Sacroiliac Injection

→ RF Ramii Communicantes

Appointments by Phone
Calls may be monitored or recorded for quality purposes.

Edgewood, Kentucky
162 Barnwood Drive
Edgewood, KY 41017
(859) 331-4159 • Fax (859) 331-4163

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