First Visit Overview
Chronic pain management begins with a new patient evaluation. Every new patient is required to complete a new patient questionnaire and sign a release of information. The physician will review all pertinent medical records, obtain a history and perform a physical examination. Diagnoses will be formulated and a treatment plan will be implemented.
You must arrive with the following information:
- State of Ohio Driver License or State of Ohio issued identification card
- Insurance Card
- Insurance Copay
- Completed new patient packet
- Medical records
- Radiology: MRI, CT, or xray on CD or film
Download Patient Information Forms
If you have any questions about the forms or your upcoming appointment, please call us to speak with one of our friendly staff members. (614) 442-0700
All forms are required.
Complete New Patient Package
Release of Medical Information
CCPC Financial Policy
Referral Form for Referring Physicians
If you do not have proper identification, your insurance card, or copay, you will be asked to reschedule.
If your insurance is through your spouse, you will be asked for their date of birth and social security number for us to process the claim. If you are unable to provide this information, you will be asked to reschedule
What to Expect
All consultations and new patient evaluations require a referral from a Health Care Provider. This referral may be generated from your primary care physician, specialist physician, chiropractic physician, urgent care, emergency department, nurse practitioner, physician assistant, physical therapist, or psychologist. We also appreciate the referral of our patients’ friends and family. This does not require a referral from another Health Care Provider unless required by the insurance company.
Continuity of Care
All patients will be evaluated, a diagnosis will be provided and a treatment plan will be formulated. The patient will be maintained in our practice until their condition improves and treatment is no longer necessary. Referrals are made to other specialists when indicated.
Once you are a patient of Capital City Paincare, you are always our patient. If you develop a new painful condition or re-exacerbation of your previous condition, you may call and schedule an office appointment. You do not need a new referral unless your insurance changes and it is required by your new insurance company. Our staff will coordinate with your primary care physician any required prior authorizations.
- Medical Mutual Medicare Advantage
- Anthem and out-of-state Blue Cross/Blue Shield
- Medical Mutual of Ohio
Bureau of Workers' Compensation
Capital City Paincare is a provider for Ohio BWC. Please note that C9 approval is required for every office visit or injection.
If you are active duty military personnel, Tricare requires a prior authorization to be submitted by your primary care physician for every office visit.
Insurance Plan Not Listed?
You may also check with your insurer to see if the doctor participates in your specific plan. Your insurer may identify Dr. Blake as a provider under her name or they may identify her under the company name, Capital City Paincare or under the Federal Tax ID, 27-3863822 or NPI number, 1740584176.
Personal Injury Patients
All personal injury or motor vehicle accident patients require a letter of protection from their attorney. Consultation will not be scheduled until this is received. Capital City Paincare does not bill government or commercial insurance for medical bills resulting from personal injury with pending litigation. Please discuss this with your attorney prior to scheduling.
Capital City Paincare does accept self pay patients and offers a cash discount. We offer evaluation and management and injections at a deeply discounted price. If you lose your insurance, we will continue to provide your medical care. Our goal is to get you back on your feet and back to work.
If you are a new patient and are looking to pay cash for narcotic management, we are not that practice. Please check www.suboxone.com for Suboxone practices accepting new patients.
Capital City Pain Care is not contracted with Ohio Medicaid or any managed Medicaid plans. We also do not accept Medicaid as a secondary insurance.