Patient Forms
1. Questionnaire: This form has critical initial health information needed for us to take good care of you.
2. Pre-authorization request: This form is to ensure coverage of your visit by your insurance company. Complete the insurance section within.
3. Medical Release Form: This form authorizes us to request release of medical information from other health care providers and the results of diagnostic testing.
4. HIPAA form: This form ensures compliance with patient privacy.
5. Guidelines: Guidelines for chronic opiate therapy
For more information or to schedule a consultation, please contact us today.
Call 702.739.8323 or send us a message on the Contact Us page. Hablamos Espanol
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For Patients:
Below are six different forms we will ask you to complete (to the extent possible) prior to your visit.
Click on the form title to download a copy.
Call us at (702) 739-8323 if you have questions.
Henderson
9029 S Pecos Ste 2800
Henderson, NV 89074
Las Vegas
3100 W Charleston,
Ste. 204
Las Vegas, NV 89102
Phone: 702.739.8323
Fax: 702.739.8605
ADVANCED PAIN MANAGEMENT CENTER -
Satish Sharma, MD & Kunal Parikh, MD
