Physician Referral

Please use this form to refer a patient.

We are able to see new personal injury patients any day of the week/weekend by appointment only.

Treatments include but not limited to:
Auto accident recovery, slip & fall, and extremity injuries.

Precision Chiropractic Care
P: 702-722-2622
F: 702-722-2050

Centennial Hills - Northwest
7541 Tule Springs Rd #130
Las Vegas, NV 89131

East Flamingo - Southeast
3530 E Flamingo Rd #140
Las Vegas, NV 89121

Patient Name

First Name

Last Name

Patient Phone

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Select Clinic Location

Referring Physician Office

Referring Physician

First Name

Last Name

Phone

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Is this for a personal injury case?

Notes