Please download and complete the Patient Information and Patient History forms found under the patients’ tab. We request that you bring the completed forms to your appointment with you. Do not bring or mail the forms to our office prior to your appointment.

Choose the correct form(s) from the forms listed to the right and then click to download.

*Note: To view or print these forms, you will need Adobe Acrobat Reader. Click here to download it.


The doctor would appreciate having all X-rays, imaging studies (MRI, etc.), and diagnostic tests (EMG, etc.) at the time of your visit. You must have had an MRI of the applicable area of the spine within one year for your appointment with Dr. Rudin.

You will not be seen if you do not have the MRI film or disc with you. Also, please bring a history of current medications and dosages, as well as your preferred pharmacy name and address.

Please bring your insurance card so that we can scan it into your chart and be able to bill your insurance directly.

First State Spine currently accepts all major insurances.

If your insurance requires an authorization from your Primary Care Physician (PCP), please obtain the necessary referral prior to your appointment.

Please be prepared to pay your copay at the time of your visit.

If you are being treated for a Workers’ Compensation or auto injury, the following information is helpful in processing your claim:

  • Date of injury
  • State where the injury occurred
  • Insurance Company Name
  • Insurance Company Address
  • Claim Number
  • Adjuster’s Name and Telephone Number
  • Attorney Name and Telephone Number (if applicable)

Please try to arrive 15 minutes early for your appointment to finalize any registration details.

Any questions regarding the above information, feel free to contact us at 302-731-2888.