Client Forms

Good Communication Means Better Case Management and Less Stress

Our customer care team is available by phone Monday through Sunday, 7:00am to 5:00pm.

General Forms

• New Client Form – Download & Print / Fill Out Online
  To be completed by you and then brought with you on your first visit.
• Credit Card Authorization Form / Fill Out Online
  To be completed by you & faxed to: 702-262-7000
• Prescription Refill Form
• Authorization for Treatment Form
• Client Info Sheet
• Recheck Patient Medical History Questionnaire
• New Patient Questionnaire

Cardiology Forms

• Authorization for Treatment Form
• Cardio CPR Level Form
• Client Info Sheet
• New Patient Medical History Questionnaire

Internal Medicine Forms

• Authorization for Treatment Form
• Client Info Sheet
• New Patient Questionnaire
• Recheck Patient Medical History Questionnaire
• New Consult Request Form

Neurology Forms

• Authorization for Treatment Form
• Client Info Sheet
• New Patient Questionnaire
• Recheck Patient Medical History Questionnaire

Ophthalmology Forms

• Authorization for Treatment Form
• Client Info Sheet
• New Patient Questionnaire
• Recheck Patient Medical History Questionnaire

Rehabilitation Forms

• Client Info Sheet
• Authorization for Treatment by the Rehabilitation Department of LVVSC