This section provides secure referral forms for healthcare providers and patients. Physicians and other referring providers: Use the Referral Form to request a consultation for your patient. This form is for medical referrals involving pain management, interventional procedures, integrative treatments, osteopathic manipulative treatment, acupuncture, or related conditions. Attorneys, case managers, or patients involved in personal injury cases: Use the same Referral Form to submit referral details for evaluation and treatment related to accident/injury cases. 

Important: Completed referral forms must be sent securely via our HIPAA-compliant email: frontdesk@lokclinic.com” 

Do not upload protected health information (PHI) through unsecured channels or public forms on this page. For your privacy and compliance, please attach the completed PDF form directly to an email sent to the address above. After submitting via email, our team will review your referral and contact you within 1-2 business days to schedule an appointment or request additional information. 

Questions? Call our office at (702) 732-1063 or (702) 732-0178 or email frontdesk@lokclinic.com. Thank you for choosing Lok Clinic for your pain management and integrative care needs