Family Practice, Family Medicine, Family Physician, Doctor in Elko, NV, Dr. Simon, Simon Family Medicine, Dr. Simon Elko, NV. Wells, NV, Doctor, Dr. Simon, Family doctor, Sports Physicals

Office Hours

Monday-Thursday
8:15a.m. to 5p.m.
closed one hour at noon for lunch

Friday
8:15a.m.-12:00p.m.

Call 775.777.8008 for an appointment.

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NEW PATIENTS

To expedite the check-in process, please complete the forms below. You may complete the Patient Information Form and the Patient History Form securely online or you may print and complete them on paper and bring them in with you to your appointment.

 

Patient Information Form (required) PDF (download and print)    or Online form
     
Patient History Form (required) PDF (download and print)    or Online form
     
Patient Bill of Responsibility (required) PDF (download and print)  
     
Assignment of Release/Acknowledgement of Receipt of HIPAA Notice (required) PDF (download and print)  
     
HIPAA Notice PDF (retain for your file)  

 


Useful Forms
Authorization for Medical Records Release    
Diabetic Testing Log Sheet (Insulin Dependent)
Diabetic Testing Log Sheet (Non-Insulin Dependent)