Please share your preferred contact information, and our new patient care coordinator will reach out to you shortly.

Full Name *

Phone *

Email *

Let's see if Ortho Las Vegas can help you feel better, faster.

Answer a few quick questions (takes less than a minute).

What area is giving you the most trouble right now? *

Knee

Shoulder

Hip

Elbow / Wrist / Hand

Foot / Ankle

Back or Neck

Have you had a replacement on the knee you would like evaluated?

Yes

Have you had a previous replacement on the shoulder you would like evaluated?

Yes

Have you had a replacement on the hip you would like evaluated?

Yes

How long have you been dealing with this issue? *

Less than 1 month

1-3 months

3-6 months

6+ months

Have you tried any of the following before?

Cortisone, Steroid or HA injections

PRP (Platelet Rich Plasma) or Stem Cell Injections

Surgery

Physical Therapy

Nothing yet - just exploring options

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Which of the following best describes your insurance coverage? *

Medicare

Medicaid

All Other Insurance Providers (Ex: Aetna, BCBS, HPN, Cigna, UHC, Humana, UMC, Tricare etc.)

Self-pay or HSA/FSA

Unfortunately we are not currently in network with your plan. Many of our out of network patients see us through our self pay option that allows us to treat patients regardless of insurance. If you would like to be seen by one of our outstanding providers, we can schedule you for an exam and x-rays at the self pay rate.

Yes, I would like to know more

I no longer wish to proceed with an appointment

Many of our out patients see us through our self pay option that allows us to treat patients regardless of insurance. If you would like to be seen by one of our outstanding providers, we can schedule you for an exam and x-rays through self pay. The self pay rate is $300 to $400, depending on our provider. We will take this payment at the time of scheduling to reserve your time slot.

I would like to schedule

I no longer wish to proceed with an appointment

The self pay rate for an initial consultation is $300 to $400, depending on our provider which includes the X-Rays and exam. We will take this payment at the time of scheduling to reserve your time slot.

I would like to schedule

I no longer wish to proceed with an appointment

Who is your current insurance provider or plan name?

Optional Image Upload- If you aren't able to upload an image, we can help determine your coverage over the phone.

Upload the front of your insurance card here

Upload the back of your insurance card here

Why? This allows our team to pre-qualify your insurance before we call you so we can give you the most accurate information about your coverage.

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Is there anything you can share about your pain/ injury, previous treatment, and or surgical history before we contact you?

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