Patient Forms

1. Questionnaire: This form has critical initial health information needed for us to take good care of you. 

2. Pre-authorization request: This form is to ensure coverage of your visit by your insurance company. Complete the insurance section within. 

3. Medical Release Form: This form authorizes us to request release of medical information from other health care providers and the results of diagnostic testing.

4. HIPAA form: This form ensures compliance with patient privacy. 

5. Guidelines: Guidelines for chronic opiate therapy

6. Cancellation policy

For more information or to schedule a consultation, please contact us today.
Call 702.739.8323 or click on the "Book an Appointment" tab at the top of the page.  Hablamos Espanol

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For Patients: 
Below are six different forms we will ask you to complete (to the extent possible) prior to your visit. 

Click on the form title to download a copy. 
Call us at (702) 739-8323 if you have questions. 
9029 S Pecos Ste 2800
Henderson, NV 89074

Las Vegas
630 S Rancho Ste H
Las Vegas, NV 89106

Phone: 702.739.8323
Fax: 702.739.8605