Patient Registration Forms

Save Time and Complete Your Secure Registration Forms Online

New Patients

All New Patients, or those patients that have not been seen in the last 12 months – are required to complete BOTH Packet 1 and 2.

Packet 1



Packet 2

Patient History

Review of Systems

Reason for Visit – English

Reason for Visit – Spanish

Established Patients

Established Patients who have been seen within the last 12 months, being seen for a New Problem, ONLY complete Packet 2.

Packet 2

Patient History

Review of Systems

Reason for Visit – English

Reason for Visit – Spanish

Requesting an Appointment

New Patients | Workers’ Comp

Communicating with our Practice

Communicate With Us

About Security

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.

Read-Only Instructions Here.

Frequently Asked Questions

Please answer all questions completely and if you do not have an answer, please enter NONE when possible.

All dates must be entered month, day, year ( XX/XX/XXXX).

The State field requires two letters Ex: NV or CA.

Requesting Medical Records

Download Our Release Form | Download Patient Request to Amend Protected Health Information Form

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

Please allow 10-14 business days for us to process your request.

Request an Appointment