For assistance, please call
402-488-7400
All patients fill out before your appointment.
Patient Demographic Form
Wellness Visit Questionnaire
Records Transfer Request**
Fill out if you are a new patient to our clinic.
New Patient Intake Form
Medicare Authorization and Questionnaire
Only for those covered by Medicare
Clinic Policies and Notices
Telephone Call Policy and Fees
Costs may be incurred
depending on time of day and length of call.
Privacy Notice
Detailed information
about how we protect your privacy.