Patient Forms

Patient Forms are in PDF format.  Adobe Reader is required.  Click here to download Adobe Reader for free here.

These forms are available in Spanish upon request at (702) 641-2150.

18-24 Month Developmental Screening

ADD ADHD - Family

ADD ADHD - Teacher

Authorization for Disclosure of PHI

Personal Information Sheet

Record Request

Registration Packet Insurance

Registration Packet - Cash

Registration Packet - Medicaid

Temporary Medical Guardianship

Treatment Authorization

HIPAA Notice of Privacy Practices

 

 

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EAST
2150 S. Eastern Ave
Las Vegas, NV 89104
Phone (702) 641-2150
Fax 702-641-8667

WEST
7180 Cascade Valley Court #180
Las Vegas, NV 89128
Phone (702) 641-2150
Fax 702-228-1043
Billing/Referrals
1840 E. Sahara #212
Las Vegas, NV 89104
Phone (702) 892-8007
Fax (702) 892-8193
Disclaimer:

This website has been designed by Desert Pediatrics to provide information of a general nature. It is not intended to be a substitute for the medical advice provided by one's practitioner. Visiting the website DOES NOT establish a patient-physician relationship with any physician or practitioner associated with Desert Pediatrics. If you need information of a specific nature, please contact our office.

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