New Patient Paperwork

Premier Pain Relief offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) or bring them with you to your appointment.

1. For CDL/DOT Physical Medical Exams:

All necessary paperwork will be provided for you.

Please bring your current Medical Card and your Driver License, eyeglasses, and hearing aid to the appointment. If you have Obstructed Sleep Apnea, you will need to bring a CURRENT Sleep Apnea Compliance Report Signed by your Sleep Apnea Doctor. CAUTION: DO NOT consume caffeinated beverages or any nicotine products 30 minutes to 1 hour before your appointment as this will raise your blood pressure.

2. For New Patients:

Please click BELOW on the "New Patient Paperwork". Print the paperwork, fill it out entirely and bring it with you as well as a valid Florida Drivers License to your appointment.

By Appointment Only

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 2:00pm


Premier Pain Relief
340 South Beach Street #112
Daytona Beach, FL 32114
(386) 679-7246