As a new patient and in anticipation of your visit, please complete the following forms, either online or download and print, and then bring them with you on your first visit. This will allow the physician more time to address your healthcare needs. If you have any questions, please call the business office at 702-341-6610.
If you need Adobe Acrobat to read these PDF files, click here for a free download.
You have 2 options:
- Fill in your forms and submit online.
- Download, print and complete the forms, bring them with you on your first visit.
Online Patient Forms
Instructions: Click the link below to open a single online version of all forms.
•You will need Acrobat Reader to complete these forms online: Get Acrobat Reader free
•Fields to be completed will appear in light blue
•Please complete all fields in blue, signature fields should be left blank and your complete form will be available to sign at the office.
•When you have completed all fields, locate the Submit Form button in the upper right of the Acrobat Reader window
•You will be prompted to select what email program type you use to send email, select the appropriate answer. Send.
• IF YOU ARE RECEIVING AN ERROR, please close any open email programs and click submit again. This often resolves the error.
• IF YOU ARE USING ON ONLINE MAIL PROGRAM, LIKE GMAIL OR YAHOO,
• ID/Insurance: You are also welcome to scan your ID and Insurance card information and attach in a separate email to: firstname.lastname@example.org
Printable Patient Forms
Spanish Language Forms