Patient Forms

Patient Forms

For your convenience, we have provided the following patient forms for you to print and complete before your office visit.

Please see our clinic policy on appointments missed or cancelled the same day. Also, please refer to below link for Medicare policy on no-show fees. Click here

Fax forms to (775) 322-4747 and bring originals to your first appointment.

Mail or bring in your forms to 540 West Plumb Lane, Suite 1A, Reno, NV 89509.

  1. Adult New Patient Paperwork - Patients over the age of 18 will need to fill this paperwork out fully completed before the appointment.  All new patient forms must be completed and returned at least (3) business days prior to your first appointment.
  2. Pediatric New Patient Paperwork - Patients under the age of 18 will need to have a parent or legal guardian fill this paperwork out fully completed before the appointment.  All new patient forms must be completed and returned at least (3) business days prior to your first appointment.
  3. Patient Information Update - Please use these forms to update any new information.  Only the updated information needs to be filled out.  Address, name, and insurance changes need to be reported to our office at least (3) business days prior to your next appointment.
  4. Consent for the Release of Patient Information - If you would like us to send records to either you, or a third party, then please fill out this form as specific as possible.  Requests for medical records can be made by completing the patient release form and faxing or mailing it to our office. Requests take about 2-4 weeks to be fulfilled. Records for private use are 60 cents per page. Records sent to another medical provider are done so at no charge.
Email filled patient forms:

Patient Name (required)

Patient Email (required)

1. New Patient Packet

2. Patient Updates

3. Patient Records Release Form