Patient Registration Forms
Save Time and Complete Your Secure Registration Forms Online
Frequently Asked Questions
What do I write if I do not know an answer on the form?
Please answer all questions completely and if you do not have an answer, please enter NONE when possible.
What is the best way to write dates on the form?
All dates must be entered month, day, year ( XX/XX/XXXX).
How do I enter a State on the form?
The State field requires two letters Ex: NV or CA.
Do I need to complete the form 5-Spine Patients, if I am not seeing a physician for my spine?
The 5-SPINE PATIENTS-Review of Systems form is only required for patients with appointments for the neck/ back/ spine, scheduled with Patrick S. McNulty, M.D. , Reynold L. Rimoldi, M.D., or Thomas L. Vater, D.O. If your appointment is scheduled with another Nevada Orthopedic & Spine physician, you may skip this form.
Nevada Orthopedic & Spine Center Patient Forms utilizes a secure hosted form service called Practis Forms. Practis Forms:
- uses servers that are managed twenty four hours a day, seven days a week and located in a SOC 2, Type II audited facility that is located in the United States.
- applies 256-bit encryption to data prior to any transmission via a SSL connection.
- user access is facilitated using the HTTPS protocol (SSL – secure socket layer) with 256-bit encryption. Non-secure access in not permitted.
- data is submitted through secure connections is encrypted and stored within a separate dedicated database server using a minimum 256-bit encryption.
- submitted data is only accessible by HIPAA trained, Nevada Orthopedic & Spine Center staff.
Do you need to Request an Appointment?
Do you need to communicate with us?
Learn more about our Patient Portal or Login
Do you need to Request Medical Records?
After you complete the request form, you can return it to us in the following ways:
- Fax: (702) 258-3779
- Mail: 7455 W. Washington Avenue, Suite 160, Las Vegas, Nevada 89128
- Hand Deliver: You can also drop off the form at any of our two locations in Northwest Las Vegas and Henderson.
Please allow 10-14 business days for us to process your request.