If you prefer or choose not to use online medical forms, you can print these forms and fax them to 702-948-9488 or bring them with you to the office. Thank you.
I acknowledge that this form may not be secure. Any health information I choose to share on this form is at my own risk.
Please bring pertinent records, medication, supporting laboratory, and radiology studies with you. Please note that some insurances require prior authorization- Please contact your primary provider to obtain and confirm you have the appropriate authorization. Without authorization you may not be able to see the physician. Thank you for understanding. We will contact you within 24-48 hrs to schedule an appointment.