Samantha Rafie, PhD | Chronic Pain Management
One step forward
Good for you for making this important decision for your health. You've realized by now that what you've been doing isn't working, or isn't working as well as you hoped. Let's find a better way. Starting is the hardest part, and you've now done that.
What can I expect?
In the first visit, you will share what challenges you're having and how pain is impacting your life. You will also learn about your condition, as Dr. Rafie begins the process of empowering you with the knowledge you need to move forward. You will also get to talk about who you are as a whole person and learn about Dr. Rafie's experience with chronic pain. Finally, you will leave with a plan of what to work on until next time.
Just yourself and the few items below. Please print, complete, and bring with you the following:
What should I bring?
Just yourself and the few items below. Please print, complete, and bring with you the following. Copies are available in the waiting room, if you prefer to come early and complete them there.
Be sure to spend a few minutes reviewing the Agreement section on Fees & Payment to learn about office procedures and your responsibility if you wish to seek reimbursement through your health insurance. For Telehealth visits, email all completed forms to firstname.lastname@example.org protected with a password that you provide via voicemail to the office - instructions are below.
New Patient Form
Medicare Opt-Out Form
Instructions for Passwords
Special instructions for pre-surgical evaluations?
In addition to the above items, you will need to bring a copy of your doctor's report recommending the surgery/evaluation. Also, be prepared with details of your medical history. For example, what treatments you've been through, or what medications you've tried.
Can I or should I bring anyone?
For the first visit, plan to leave family members, children, and pets at home. This way, we can ensure that you get the undivided attention you deserve and they have supervision. We can discuss the possibility of including family members down the line, if it seems it would be beneficial.
After your appointment has ended, you will receive an invoice to your email address of record. You will be prompted to enter credit card information via a secure third party site, Square. Many people choose to save their credit card information so that future appointments can be automatically charged without requiring additional steps. You will receive an emailed receipt after the transaction is complete.
For those wishing to seek reimbursement through their health insurance, you may request a summary of your payments to then submit and pursue on your own. For those with Medicare, you may choose to be seen in this office at your expense or request a referral to an in-network provider.
At this time, all visits are being held via synchronous audio/video systems to provide a healthy environment for us all. Although we all like in-person contact, we feel this is the best option.
Located in The Shops at La Jolla Village, our office is directly above CitiBank. There are stairs and an elevator for your convenience. To honor your privacy, the doctor's name appears on a small building directory, but you will not see a large public-facing sign.
The address is 8813 Villa La Jolla Drive, Suite 2002 in La Jolla, CA 92037.
Once in the waiting room, please make yourself comfortable and enjoy a beverage, if you like. There will be a clipboard waiting for you with forms to complete before your appointment. Please arrive 15 minutes early to your first visit. For surgical evaluations, please arrive at least 30 minutes early to complete these forms.