Patient Info

Patient Forms at NJ Pain and Spine center

NJ Pain and Spine center


  • Informed Consent

  • Patient Instruction

  • Endoscopic Assisted Microdiscectomy

Patient Bill of Rights

You Have the Right…

  • Not to be denied participation in all treatment services based on the grounds of race, color, creed, sex, sexual orientation, national origin, disability, diagnosis, religion, age or socioeconomic status.
  • To be treated under considerate and respectful care.
  • To reasonably expect from staff members responsible for your care and welfare, and receive complete and current information concerning your condition.
  • To know by name and position the staff members responsible for your care.
  • To reasonable consideration of your privacy and to be treated with respect and full recognition of your dignity, individuality, and reasonable cultural needs.
  • To expect a reasonable response to your requests.
  • To be free from all forms of abuse or harassment, neglect, or exploitation.
  • To be reasonably informed at the time of check out of medical and/or ancillary services charges.
  • To be afforded the opportunity to participate in planning and implementing your treatment program, to refuse care, treatment or services in accordance with law and regulation.
  • To the maintenance of confidentiality of your clinical record.
  • To access information contained within your medical record.
  • To be informed, when appropriate, about the outcomes of care, including unanticipated outcomes.

You Have the Responsibility…

  • To be honest about matters that relate to you as a patient.
  • To provide staff with accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters pertaining to your health.
  • To report any perceived risks in your care.
  • To report any unexpected changes in your condition to those responsible for your care and welfare.
  • To follow the care, service or treatment plan developed.
  • To ask any questions when you do not understand or have concerns about your plan of care.
  • To understand the consequences of the treatment alternatives and not following your plan of care.
  • To know the staff who are caring for you.
  • To be considerate and respectful of the rights of both fellow patients and staff.
  • To honor the confidentiality and privacy of other patients.
  • To be considerate of the property of NJ Pain & Spine Specialists.
  • To assure the financial obligations of your healthcare are fulfilled as promptly as possible.

If you did not find the answer to your personalized question regarding your pain diagnoses, examinations and pain treatment, feel free to let us know.