Welcome to Valery D. Tarasenko, MD


Welcome Practice Information Services We Provide Physician Profiles Testimonials How To Refer To Us Patient Forms Links CONTACT US Phone: 707-359-2255 Fax: 707-359-2259 FrontDesk@paininstitute.org Send a link to your friend: www.paininstitute.org Advanced Pain Management Institute 200 Butcher Road Vacaville, CA 95687		Patient Forms New Patient Package: Please carefully read the information below. Print out and fill the New Patient Questionnaire completely. Bring it to your first appointment. Initial Visit Letter Notice of Privacy Practices New Patient Questionnaire Follow Up Package: Please fill out both forms and bring to your next appointment. Follow Up Questionnaire Procedure Information and Forms: Please read and follow pre-procedure instructions carefully. Fill out the first two pages and bring with you to the procedure. Procedure Questionnaire Things to Remember Before Procedure Suboxone Detox Information and Forms: Please fill out all the forms and bring them to your first appointment. Suboxone Detox Questionnaire Suboxone Detox New Patient Agreement Wellness and Weight Loss Information and Forms Ideal Protein Health Profile Ideal Protein Website

Patient Forms