Advanced Pain Management

19850 Lake Chabot Road
Castro Valley, CA 94546

For After-Hours Emergencies:
Call (510) 582-8555 and follow prompt to connect to on-call doctor.
For Life-Threatening Emergencies Call 911

© 2019 Advanced Pain Management Inc.

Our Patient Portal is an easy way for new patients to register online

without the need to download and send in forms.  Click here to give it a try

New Patient Form  

Click the icon above to download the New Patient Form. Print this form, complete it, and bring it to your initial consultation.  In addition to this form, please bring in a photo ID, insurance card, physician referral (if applicable), and any pertinent MRIs, CTs, Xrays, and medical reports.

HIPPA Authorization Form  

Click the icon above to download the HIPPA Authorization Form. Print this form, complete it, and bring it to your initial consultation.  
 

Referral Form  

Click the icon above to download the Referral Form. Print this form, complete it, and bring it to your initial consultation.  

Prescription Guidelines  

Click the icon above to download the Prescription Guidlines. Print this form, complete it, and bring it to your initial consultation.  

For after hours emergencies
You may call (510) 582-8555 and follow the prompts to get in touch with the on-call doctor.

Cancellation Policy
We require you to provide 24 hours notice prior to canceling your appointment.  This provides us an opportunity to schedule a patient from our waiting list.  You may be charged a fee for not showing up to your scheduled appointment or failing to provide adequate notice of cancellation.  Thank you in advance.


Insurance
We participate with most health insurance carries in northern California including Worker’s Compensation.  In the event that we do not participate with your plan, we may be able to see you as an out of network provider or on a cash pay basis.  Contact our office for more details.