The tests and materials require a password to install or use.

Please contact Pain Assessment Resources to become an authorized customer and receive a password.

Please print this form out and complete it. Then fax to Pain Assessment Resources at 775-853-9888 or you may mail it to Pain Assessment Resources; 4790 Caughlin Parkway Suite 173; Reno, Nevada 89519.
Name and Degree:
Address: City: State:
Zip/Postal Code: Country: Email:
Telephone: Fax: Highest Degree Earned:
Graduating Institution: Area of Study: Year of Studies:
Certification and Licensing (please provide the following information)
License/Certification Number: Authorizing Agency: Expiration Date:
For All Purchasers:
I certify that the information contained in this form is accurate. I certify that any test material and/or services which I purchase from Pain Assessment Resources will be used in an ethical and responsible fashion similar to what is outlined in the Standards for Educational and Psychological Tests. I have read and understand the materials describing the PAR test I am ordering and am also familiar with the proper administration and interpretation of the test. In addition, if I am not a qualified mental health professional, I will make every effort to refer patient in need of mental health services (e.g., mood related problems).
Signature: Date:


  Pain Assessment Resources
4790 Caughlin Parkway Suite 173  |  Reno, Nevada 89519
800-782-1501  |  Office: 775-828-2955  |  FAX: 775-853-9888
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