AESOP Program Process

Our sign up is easy and has only 4 steps!

1. Fill out a new patient sign up sheet, a pre consultation questionnaire, an Informed Consent Form and a required social and medical history form.

2. Submit a copy of your driver’s license or state identification and a complete copy of your medical records no more than 1 year old please. These records need to include all laboratory results including a CBC and CMP-14, urinalysis and toxicology screen. AESOP has a contractural arrangement with Omni MD, a computer based medical records repository. Omni M.D. complies with all HIPPA laws and regulations relating to privacy, confidentiality etc. Your medical records will NOT be shared with any other third party (Other than Omni MD) without your express written consent. After you sign the Informed Consent form and your medical records are received by AESOP, your records are scanned and immediately forwarded on to Omni MD and a secure, private medical file is established in your name pursuant to Indiana law and federal regulations, all of your diagnoses, treatment and prognosis and all records relating thereto.

3. Purchase a webcam if you do not already own one for consultation with our pain management specialist. You will also need Yahoo Instant Messenger. Please send in your screen name in the form of an email.

4. Set up a consultation with our pain management specialist. Payment for the consultation is due immediately and must be made before your your consultation can be confirmed.

If you experience any technical difficulties or have any questions feel free to contact our Executive Assistant at 1-866-868-9717 or by email at signup@aesop-cpmp.com.