Nevada Patient Forms

Select the intake form that matches your treatment at our Las Vegas clinic

Las Vegas Clinic

5145 South Durango Drive, Suite 103, Las Vegas, NV 89113

Phone: 844-552-7489

Select Your Treatment Form

Choose the form that matches your planned treatment

Chronic Pain

Ketamine therapy intake form for chronic pain management

Complete Form

Depression

Ketamine therapy intake form for depression treatment

Complete Form

Drug & Alcohol Addiction

BR+NAD therapy intake form for addiction recovery

Complete Form

NAD+ Therapy

IV NAD+ and multivitamin therapy intake form

Complete Form

Medical Records Release

Download and submit your authorization form

Authorization to Release Medical Records

Your medical records assist us in tailoring your treatment to your specific conditions. Download this form, complete it, and forward to your managing professional.

Download PDF Form

Need Assistance?

If you have questions about which form to complete or need help, our team is here to assist you.