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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

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Diagnosis

Labs performed

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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!

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Referring Practitioners

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