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Medical Forms

To make your visit to Phillips Clinic more convenient, please take a few moments to download and complete the forms below. As always, we would be happy to answer any questions you may have and please be sure to call us in advance of your appointment if anything comes up. We look forward to seeing you soon.

New patients - please fill out forms 1 through 4 and bring to your office visit; if you have chronic pain issues and may need pain medications please also read over the pain contract.

Established patients - please fill out form 1 prior to a physical exam; if you have changes to contact information, insurance, etc. please fill out a new patient registration form as well, so we can update your information.


5970 South Rainbow Boulevard Las Vegas, Nevada 89118  Phone: (702) 363-4000    Fax:  (702) 362-0086   Email: phillipsclinic@cox.net
Office Hours:
Monday  8:00 - 5:00  Tuesday  7:30 - 6:00  Wednesday  7:30 - 6:00  Thursday  7:30 - 6:00  Friday   8:00 - 5:00 Saturday  9:00 - 4:00
CALL US AT 
 702-363-4000
Phillips Clinic 
Family Practice & Anti-Aging Medicine