Ellen Merkin OD
  • Home
  • Our Practice
  • Our Services
  • Patient Forms
  • Eye Care Articles
  • Location

Patient Forms       

Patient Forms

Patients can now download our medical forms below and have them completed when they arrive at the office for their appointment. We hope that this will save some time and let you enjoy the rest of your day.
Welcome Form
File Size: 48 kb
File Type: pdf
Download File

Medical History Form
File Size: 83 kb
File Type: pdf
Download File

Dry Eye Questionnaire
File Size: 107 kb
File Type: pdf
Download File

Insurance Assignment and Release
File Size: 51 kb
File Type: pdf
Download File

Authorization and Privacy Receipt
File Size: 143 kb
File Type: pdf
Download File

Notice of Privacy Practices
File Size: 262 kb
File Type: pdf
Download File

Contact Us
2920 So. Rainbow #120
Las Vegas, NV 89146
Phone: 702-363-7372
Office Hours
Mon  - Tue:  10:00 am - 6:00 pm
Thu - Fri:       10:00 am - 6:00 pm
Saturday:      10:00 am - 4:00 pm
Wed & Sun:  Closed
Notice of Privacy Practices
Website by Eyefinity


​Due to an increase in same day no shows, we now charge $25 for cancellations without 24 hours notice.

  • Home
  • Our Practice
  • Our Services
  • Patient Forms
  • Eye Care Articles
  • Location