Medical Authorization Forms

New Patient Forms

Please fill out your health history form and bring it with you on the day of your appointment. We will need the completed form and your insurance card before you receive treatment.

Contact

Address :
Located inside Bryan Medical Center West:
2222 S. 16th St. Ste 305, Tower B
Lincoln, Nebraska 68502

Phone : 402-488-3002
Fax : 402-483-8787

Financial Forms

To register for your Patient Portal Account – please contact the office for a token number or for a secure email link to be sent to you. Once you have a patient portal account set up with NSS you may register with MyLinks to store all your healthcare data from multiple practices in one application. Please contact the office for more information.

These forms are in Adobe Acrobat format. If you don’t have Adobe Acrobat, click here for a free download.

Telehealth Links