Patient Forms and Information
If you have any questions or need help filling out a form, please call us at 402-378-9504.
Monday – Friday: 8:00am – 4:30pm
Appointments may be scheduled by calling (402) 378-9504. Patients will not be seen on a walk-in basis. If you are a new patient, please arrive 30 minutes before your scheduled appointment to complete necessary paperwork.
In an effort to provide timely care to all of our patients, it is our policy that if you are unable to attend your scheduled appointment, please call to cancel no later than 24 hours before the scheduled time. “No shows” will result in a $75 fee per occurrence.
Please understand that due to unforeseen circumstances, appointments may be postponed. Our staff will make every effort possible to minimize delays.
It is our policy that no prescriptions will be refilled on weekends or evenings. We request at least 24-48 hours to process all medication refills. Please plan accordingly.
Your medical records are confidential. If you wish to have copies of your office records released to another provider, please send a written request authorizing release of the records. Medical records requests, disability forms, or letter requests may require 7-14 days to complete. Please inform our office of any changes in your name, address, employer, telephone numbers, and health insurance coverage.
We participate with the following insurance companies:
- Blue Cross/Blue Shield
- Iowa Medicaid
- Midlands Choice
- Nebraska Medicaid
- United Health Care
- Most other commercial carriers
- Worker’s Compensation
Click below to download a PDF version of one of our forms.