Patient Info + Forms
Current Patients ▸
Online Bill Pay Portal
24-Hour Access to Your Health Information.
The online DPC Patient Health Information Portal provides secure, easy and private access to your personal DPC health information – 24 hours a day!
Insurances Accepted
Doctors Pain Clinic accepts commercial insurances as well as Medicare, Medicaid and Workers’ Compensation. Payment plans are available upon request.
Please Note: Not all insurance plans are accepted at all Doctors Pain Clinic office locations.
Questions about a particular insurance?
Toll Free: 888-784-4312
Phone: 330-629-2888
Changes in insurance: Any changes in insurance provider, home address and telephone number must be reported to the billing department.
Patient Bill of Rights
Release of Medical Records Form
Federal Trade Commission Red Flag Rules
Patient Billing ▸
PAYMENT METHODS ACCEPTED: Cash, Personal Check, MasterCard, VISA, and Discover Card.
ONLINE BILL PAY: Use our secure, online bill portal.
CO-PAYS: Must be paid in FULL on the day of your visit.
BALANCES: A payment must be made toward your balance at every visit or future appointments will not be scheduled.
COLLECTIONS: If you are in collection, appointments will not be scheduled until your balance is paid in full.
PAYMENT PLANS: Available upon request.
QUESTIONS?
Billing Department
Toll Free: 888-784-4312
Phone: 330-629-2888 Ext. 140
Patient Forms
Physician Referral Form
Patients: select the referral form with location you would like your physician to refer you. Take the form to your primary care physician to obtain a referral.
Authorization for Release of Information
Annual Patient Forms
Effective every January 1st, existing patients are requested to complete the forms below for each year. Please print and complete before your next appointment.