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(702) 263-2020
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Exclusive Offer

New Patients Receive Free Lasik Consultation. Contact us Today!

As part of our New Patient Center, we have compiled the forms you will need to fill out prior to your first visit with us. Unlike some offices that bombard you with paperwork as soon as you sign in, we give you access to forms so that you can fill them out at your own pace and in the comfort of your home or office.

We want your transition to our office to be smooth. Your time here should be spent relaxing and getting to know the staff that will be caring for you, not attending to questions and shuffling through papers.

All of our online forms are devised to give Dr. Brett D. Brimhall a view of your medical history and help the ophthalmologist comprehend your questions, concerns and goals regarding your eye and vision health. This information is essential, as Dr. Brimhall uses it to better grasp your needs and provide quality care.

Here's how it works:

  • Download the forms with AdobeReader® and then print them out. If you do not have AdobeReader, you can Download AdobeReader® for free.
  • After you have downloaded and printed the forms, complete the required information.
  • Fax your completed forms to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Patient Registration Form - Download & Print

HIPAA Medical Information and Privacy Form - Download & Print

Online Registration - Click Here

If you have any questions, please do not hesitate to contact our office by calling (702) 263-2020.

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Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.