Patient Referral Form
Print the patient referral form for your doctor. The instructions are included on the second page.
Once your doctor completes the form it can either be faxed or mailed to LVS. You should expect a phone call from us to schedule an appointment within 48 hours.
Print or Download
To print the form directly from your browser, click the download button and the form should open in a new tab or window. You may then print it.
To download the form, right-click the button with your mouse and select ‘Save link as…’
Note For Chrome Users
If printing the referral form directly from Chrome, you may need to change the ‘Scale’ option to 100 or place a checkmark next to ‘Fit to page’ on the print options side panel (after selecting Print).