Dr. Gatell's On-Line Consultation & Professional Fees !

Dear Chronic Pain Sufferer:

This is an Online Medical Consultation Form, using  a secure SSL form to send your private medical data over the Internet, before your first consultation with Dr. Gatell at The Angel Pain Relief Center. We also suggest that you use a 128 bit browser or better security available from Netscape and Microsoft.

Using this form, you will be able to send Dr. Gatell your medical information in a secure and more organized fashion, in order to begin putting information together for a professional Medical Pain Management Consultation even before you arrive on your initial visit.

MOST IMPORTANTLY BEFORE YOUR FIRST VISIT WITH DR. GATELL, YOU WILL ABSOLUTELY NEED A PRIMARY CARE DOCTOR WHO CAN VERIFY THAT YOU ARE NOT A DRUG ABUSER NOR A PSYCHIATRIC PATIENT THAT IS SEVERELY DEPRESSED AND SUICIDAL ! 

The initial fee is $240  for a 60 minute comprehensive medical evaluation and treatment of your intractable chronic pain, fibromyalgia and/or chronic fatigue syndrome. If an additional 1/2 hour is needed, a $120 fee will be added. However, Dr. Gatell will work with you as far as payments, and will accept any insurance company's usual and customary fees are usually if payments are reasonably close to his fees. Unfortunately, the "usual and customary fees" change depending on the policy within the same insurance company !

For follow-up visits, there is a charge range of $120 monthly visits to $240 for 3 month interval follow-up visits. Follow-up visits to Atlanta are anywhere from 1 to 3 months, depending on your progress and compliance with medications.

Many of Dr. Gatell’s patients have already spent $10,000 to $20,000 before seeing him. Many have undergone 2 to 3 un-necessary expensive back surgeries, when all they had was fibromyalgia, facet joint syndrome, sacroiliac joint pain and/or pyriformis muscle pain syndrome that only “looked-like” it was coming from a few small herniated discs on MRI or CT scans – only to have worse pain later – the "Failed Back Surgery Syndrome (FBSS)."

There are major savings with the expert care of Dr. Gatell at a fraction of the cost and he does get them better too ! And, if you are able to go back to work, than you gain thousands of dollars !

Dr. Gatell has been stopped participating as a Health Provider for Medicare and Medicaid. Only cash, money order or credit card will be accepted.

If you have financial difficulties with no insurance, Dr. Gatell will always try to work out a plan to suite your needs. Currently, we will accept half our initial usual professional fees in patients with financial hardship - that is a minimal of $ 120 for the initial assessment and $60 for monthly visits to $180 for 3 months follow-up visits.

Every penny will be worth it, because Dr. Gatell actually spends the time with you from an average of 45 min for follow-ups to 90 min to 120 min or more for new patients - not just 5 to 10 minutes: This is why most of his patients do much better, many within 2 to 4 weeks of his treatments ! This is truly custom care for those who really need it.

Again, Dr. Gatell has helped place patients back to work or keep those working with his very customized chronic pain management.

We do accept American Express, Visa, MasterCard and Discover Credit Cards.

Please fill out the following information before you arrival for your first consultation. Again, this will allow a better general understanding of all your problems even before arriving to see Dr. Gatell. This will also allow more time to focus on your current specific problems:

I. Identification Data:

Full Name:

Social Security Number:

Birth Date: Age: Sex: Male Female

Street Address:

Town/City:   State: Zip:

Telephone:

Are you planning a visit with Dr. Gatell in the near future ? Yes No

If yes, what approximate date would like to visit ?  approximate time ? AM PM (Please note that this is not an official scheduling - it must be confirmed by telephone after speaking with Dr. Gatell first.)

Insurance Type: (Please Note: Currently, no Medicaid and most HMOs are not accepted unless they are willing to pay out-of-network.) 

Insurance Company Name:

Full Name of Insured: 

Insured's Date of Birth: Insured's SSN:

Patient Relationship To Insured:

Policy Number (ID #): Group Number:

Insured's Employer:

II. Data On Your Local Physician (MD or DO)

Remember, that by completing this form you are allowing a Dr. Gatell to contact the following doctor to verify that you have no history of drug abuse or suicidal behaviors at anytime:

Full Name:          

Street Address: 

Town/City:     State:     Zip:

Telephone:      Fax:  

You also agree to allow Dr. Gatell to contact the following relative or friend in an emergency, or to verify that you are not a drug addict or are suicidal at anytime:

Emergency Contact: 

Full Name:        Relation:

Street Address:   

Town/City:        State:        Zip:

Telephone:

III. Your Medical  History

Don't worry this is the last but the most important section:

 

What is your Chief Complaint or Problem ?

Where in your body is your main pain (s) ?

When did this pain start ? (MM / DD / YY)

How did this pain start ?

Is the quality pain mostly ?

How intense is you pain on the average ? Scale of "1" being minimal pain to "10" being so severe it brings you to tears. 

How high does your pain get (from a scale 1 to 10) ?

What makes your pain less ?

What makes you pain worse ?

What are ALL your current medications do you take (dosage and frequency) ? - Please include any herbs, vitamins, and minerals, etc.

Please name any drug that you gave any adverse effects including allergic reactions:

What other Medical Problems have you had the past ?

What Surgeries have you had in the past ?

Any Family History of Health or Medical Problems ?

Do you smoke cigarettes ? Yes No . If "Yes", how many cigarettes per day ? What Brand ?

Do you drink alcohol ?

Marital Status ?

Do you have any major stresses now (e.g. financial, marital, etc. )or past tensions (e.g. growing-up or later in life ) ? Please comment (optional):

Review of Symptoms:

Please check symptoms that apply to you currently or in the past :

 

Tell us how to get in touch with you:

Name     
E-mail   
Tel      
FAX      

Please contact me as soon as possible regarding this matter.

John A. Gatell, M.D.
Copyright © December 10, 2007 ,  Angel Pain Relief Center. All rights reserved.