Download Admission Form

Receptionist sitting at front desk.   


To download LVPRC admissions forms, please click below:

Admission Forms

Please note the above file is 1.7 MB and may take some time to download on slower computers.

You will need Adobe Reader to view the above .pdf file. If you don't already have it, you can download it for free using the link below.

LVPRC Disclosure

LVPRC’s website of services is for information only. LVPRC does not diagnose medical conditions, offer specific medical advice. The advice or information contained does not replace consultation with your own physician for the care and treatment of any medical condition.  Discussions of possible treatment options are just that, discussions. Any treatment plan discussed at LVPRC is significantly limited by the incomplete information provided by the patient or caregiver requesting advice. These discussions are meant to be general discussions of the POSSIBLE treatment options which may exist, not specific recommendations for care. Those decisions should be left to the treatment provider who has a more complete knowledge of the patient history and physical examination. Please schedule an examination as soon as possible.