Download New Patient Paperwork
Please click on the links below to download new patient
paperwork. If you are unclear which documents to download, please call the
office at 702-877-2000. If the correct paperwork is not downloaded correctly
and/or not filled out, it may compromise your treatment time.
Patient Information/Financial
Responsigility/Cancellation Policy/HIPAA Signature Page
All New Patients Need These Forms
Please review the HIPPA policy before signing the HIPAA
Signature Page
If you are unable to download forms, please come to your first visit 30
minutes early to complete them at the clinic.
Body Pain Map
All New Patients Need This Form
If you are unable to download forms, please come to your first visit 30
minutes early to complete them at the clinic.
Medical
Screening Questionnare
All new Patients Need This Form
If you are unable to download forms, please come to your first visit 30
minutes early to complete them at the clinic.
Urological Medical History (Women and Men)
If you are being seen for Incontinence, Chronic Pelvic
Pain or Painful Bladder Symptoms
If you are unable to download forms, please come to your first visit 30
minutes early to complete them at the clinic.
Male Pelvic Pain Questinare
If you are being seen for Groin Pain or
Genital Pain, Male's Only
If you are unable to download forms, please come to your first visit 30
minutes early to complete them at the clinic.
Lymphedema
Patient Consent for Photograph/Medical History for Lymphedema
and Breast Cancer Patients
If you are unable to download forms, please come to your first visit 30
minutes early to complete them at the clinic.
Linfedema - espanol
CONSENTIMIENTO DEL PACIENTE PARA Fotografía /
Historia de la Medicina para el linfedema y el
cáncer de mama pacientes.Si
usted no puede descargar los formularios, por
favor, venir a su primera visita 30 minutos
antes de completar en la clínica.
