Instagram

This field is for validation purposes and should be left unchanged.

Thank you for referring your patient to Infectious Diseases of Southern Nevada. We take great pride in our clinical team and our commitment to quality patient care through outstanding customer service, open communication and accessibility. For a timely response from our practitioners, we request that you fill out the form below to help us assess our ability to care for your patient and triage their needs appropriately.

Patient Contact Information

Patient Name*

Patient Phone

Patient Email*

Patient Address

Street Address City State / Province / Region ZIP / Postal Code

STAT referral

Yes
No

Diagnosis

Labs performed

Yes
No

Location of most recent labs

Services needed

Consult
Infusion
Wound Care

Hospital Consult

Yes
No

If so, where?

Office Consult

Yes
No

Your request and the status of the referral will be confirmed by phone by a member of our staff. Emergent inquiries can also be handled through the main office number at (702) 776-8300. Thank you!

SMS Opt-in or Opt-out

Opt into receiving SMS
Opt out of receiving SMS

By providing my phone number, I consent to receive SMS text messages for appointment reminders, marketing messages, and general two-way communication. Msg frequency varies. Msg&data rates may apply. Reply HELP for support. Reply STOP to opt out. Privacy Policy | Terms and Conditions

Referring Practitioners

Patient Contact Information

Accessibility Tools

Accessibility Tools