Pre-visit Forms

We prefer electronic registration forms as they reduce data entry errors and waiting time in the office.

NEW PATIENT REGISTRATION FORM.  We will contact you within 3 business days to schedule an appointment.

Follow up appointment request form

Insurance & Demographics Update Form

 Spanish / Español

Formulario de Inscripción (Pre-visit form in Spanish)     Favor de traer el formulario completado consigo para facilitar el proceso de  inscripción.  Gracias.

 Chinese / 中文

中文 资料填写


Medication refill form

Surgical photo upload form (secure link via Updox)


Billing Inquiry form

Online payment portal

Pre-operative Instructions

Preop and Diet instructions  (English)

Summerlin Hospital Registration and Preoperative Instructions (English)

Summerlin Hospital Surgery Cost Information

Affinity Surgery Center Surgery Cost Information

Referral Forms for Referring Physicians


Nevada Universal Referral Form