To schedule an appointment, please call 702-630-DISC(3472)

For Patients

New Patient Forms

New Patient (Intake) Forms are available to download in PDF format both in English and Spanish.

Forms must be completed prior to being seen by the doctor. They can be completed before coming to the office or at the office.

Select the language you want. The form will open in a new window. You can either save or print the form.

Descargue la forma en Español

Entrance Application

Insurance or cash pay
Complete this packet if you weren't involved in an auto accident or workers compensation claim. If this visit is related to either an auto accident or work comp case however the case(s) are currently closed. This is the packet that you’ll need to complete.

Auto Accident or Personal Injury
Complete this packet if you were involved in an auto accident or personal injury case. You'll still complete the form if heath insurance is being used.

Workers Compensation
Complete this packet if you were injured on the job and your adjuster has either sent a referral or contacted our office to coordinate the initial consultation. DO NOT complete this form if you have a closed claim that you are trying to reopen. If you are trying to re-open a closed claim you will need to pay cash for your consultation. Therefore you would complete the insurance packet.

If you are unsure of which packet you need to complete for your visit. Please call our office at (702) 630-3472.

VISIT US:   9339 W. Sunset Road Ste 100 - Las Vegas, Nevada 89148  PHONE: 702-630-DISC(3472)   FAX: (702) 946-5115   EMAIL: info@disclv.com Privacy Policy