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.

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.  

 

1- Reason for Visit

2- Patient History

3- Patient Demographics

4- Review of Systems

5- SPINE PATIENTS - Review of Systems

6- Communication Directive

7- HIPAA Notice of Privacy Practices

8- Financial Policy

 

Do you need to Request an Appointment?

New Patients

Workers' Comp

Do you need to communicate with us?  

Learn more about our Patient Portal or Login

Communicate With Us

Do you need to Request Medical Records?

Download Our Release 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.