New Patient Forms
Please complete the forms that apply to you before your first visit and bring them with you, or arrive a little early to fill them out in our office. Questions? Call 702-444-4200.
New Patient Packet
For all new patients. Please complete before your first visit and bring it with you.
downloadPersonal Injury Questionnaire
For car accident and personal injury patients. Includes your attorney and claim details.
call for this formMinor Treatment Consent
For patients ages 2 to 17. Completed and signed by a parent or legal guardian.
call for this formProcedure Preparation Packet
Review before your procedure at the outpatient surgery center, and bring the signed consent with you.
call for this formNeed a form in Spanish? Call 702-444-4200.
FAQs
Quick answers for new patients.
What is pain management?
Pain management is a medical specialty focused on diagnosing and treating pain from injuries, nerve problems and chronic conditions. At Epion, Dr. Gallagher uses minimally invasive treatments such as epidural injections, nerve blocks and radiofrequency ablation to reduce pain and help you move and function better.
Do you treat children?
Yes. Dr. Gallagher sees patients ages 2 and up. A parent or legal guardian should come to the visit and complete the Minor Treatment Consent form.
What insurance do you accept?
We accept most major plans, including Aetna, BCBS, Cigna, UnitedHealthcare, Culinary, Medicare and Tri-Care, plus workers' compensation and personal injury liens. See our insurance page or call 702-444-4200 to verify your benefits.
Do you speak Spanish?
Sí. Dr. Gallagher is fluent in Spanish and our entire office is bilingual, so you can schedule, complete paperwork and discuss your care in English or Spanish.
What should I bring to my first visit?
Bring a photo ID, your insurance card, your completed forms, a list of your medications, and any imaging or records related to your pain. Accident patients should also bring their attorney's contact information and claim number.