Referral Form

Dr. Selznick is committed to providing the most advanced technologies available and using those technologies along with his surgical skills judiciously in helping referring doctors accurately diagnose and treat patients. You may refer patients to our office by downloading our referral form. After the form is complete, please fax it to our Las Vegas office at 702-463-3535 or our Pharump office at 775-751-1019. 

Referral Form