John D. Spears, D.O.

When spine surgery is an option,
The Missouri Spine Institute is the best option you have.

Patient Forms

While you are receiving treatment at Missouri Spine Institute, there are some forms you’ll likely need to complete. For your convenience, the forms have been categorized into Surgery Prep Forms and Intake Forms.

Please scroll through the list below and locate the forms you have been asked for. Click the yellow button to download the form and then print.

You may bring your completed forms with you to your next appointment, or you may mail them to our office.

1616 Southridge Drive Suite 202
Jefferson City, MO 65109

Surgery Prep Forms

ACDF Patient Information: You and Dr. Spears have agreed that a surgical procedure is the best option for treatment of your spine condition/problem. 

Preparation for your surgery and your participation during recovery is very important. This handbook will provide you with the information you will need before and after your surgery.

CRMC Financial Information: Capital Region Medical Center offers many forms of financial relief for patients without healthcare insurance (the uninsured) needing emergent or non-elective services.

Lumbar Spine Fusion Information: You and Dr. Spears have agreed that a surgical procedure is the best option for treatment of your spine condition/problem.

Preparation for your surgery and your participation during recovery is very important. This handbook will provide you with the information you will need before and after your surgery.

Non-Fusion Patient Information: You and Dr. Spears have agreed that a surgical procedure is the best option for treatment of your spine condition/problem.

Preparation for your surgery and your participation during recovery is very important. This handbook will provide you with the information you will need before and after your surgery.

Posterior Cervical Fusion Information: You and Dr. Spears have agreed that a surgical procedure is the best option for treatment of your spine condition/problem. 

Preparation for your surgery and your participation during recovery is very important. This handbook will provide you with the information you will need before and after your surgery.

Intake Forms

New Patient Paperwork (revised 2012): Use this form to give us your medical history and information about your current condition.

Medical Records Release Form (request from another office): Use this form to have your records sent from another provider to Missouri Spine Institute.

Medical Records Release Form (to send to another office): Use this form to have your Missouri Spine Institute records sent to another provider.

New Patient Letter: This form outlines everything you’ll need to do before your appointment and what to bring with you when you visit our office. If you have any questions, please call us at 573-635-0401.

Prescription Pain Medication Policy: This form contains our policy regarding prescriptions and refill requests.

Our office strives to provide the best service and care possible to our patients. However, it is our primary responsibility to protect patients from potentially harmful situations. Selective dispensing and close monitoring of narcotic pain medications is an integral part of providing safe, effective treatment to our patient.