Desert Valley Advanced
Pain Management


11024 N 28th Dr
Suite C160
Phoenix, AZ 85029


Phone: 602-863-3924
Fax: 602-863-3926
Desert Valley Advanced
Pain Management

Patient Forms

 

For your convenience, patient forms are available to print and fill out before your appointment.  Please print and fill out all 4 forms and bring with you for your first appointment. Click on a link below to view / print patient forms:


HIPPA Privacy Statement
109.8 KB



Office Policies
49.1 KB



Opioid Contract
70.6 KB



New Patient Packet
265.2 KB


Adobe Acrobat is required to view and print these PDF files.  If you do not have Adobe Reader you can download it free by visiting Adobe's website here.



Pre-Procedure Instructions

Metro Surgical Center
3131 W Peoria Ave, Phoenix, ax 85029
Phone # 602-375-1083

Don't eat or drink 4 hours prior to your appointment time, if diabetic 2 hours prior to.

Do take your heart , blood pressure and any other necessary prescription medications.     *  OK to take prescribed pain medication.  
*  Diabetics do not take your insulin day of.
*  You will need to have someone drive you home after your procedure.
    ABSOLUTELY NO TAXI
STAY OFF Coumadin or Aspirin or any blood thinners for 5 days prior to your procedure.
STAY OFF all non-steroidal anti-
inflammatory medications such as: Naprosyn,
   (Naproxsen) Motrin, Advil, Ibuprofen, Daypro, Arthrotec, Lodine  Orudis, Ketoprofen,   
   and Vitamin C (multi vitamin) for 3 days prior to your procedure.
* If you become ill or have a temperature (fever) over 101 degrees, the procedure will not be
    able to be  performed and will be rescheduled.
*  If you are unable to keep this appointment for any reason, kindly call the scheduling 
    phone number (602) 863-3924.
*  If you should have any questions or concerns, please don't hesitate to call the office.

You may also be asked to pay your insurance co-pay or co -insurance before the procedure. The co-insurance is determined by your insurance. The patient will need to contact his or her insurance before the procedure to find out how much your co-insurance is.

To cancel, reschedule or confirm your appointment please call (602)863-3924

All cancellation must be made 24hours prior to your appointment. If the office is not notified 24 hours prior to the your appointment there will be a $75.oo  charge that the patient will be responsible for and after your third cancellation or no show the patient can be discharged from the practice.
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