Author: Suzi Gausman

This questionnaire is to be filled out prior to making any initial appointment. Please make sure to have these completely filled out and Sent to the appropriate staff member. DOWNLOAD FORM

This packet is to be filled out prior to your initial appointment. Please make sure to have these completely filled out and bring them with you to your scheduled appointment. DOWNLOAD FORM

If your office visit is due to a work accident, please fill out the appropriate information on this form and bring it with you to your appointment. DOWNLOAD FORM

If your office visit is due to an auto accident, please fill out the appropriate information on this form and bring it with you to your appointment. DOWNLOAD FORM

If you would like your records sent somewhere outside of our office we will need this form sent in to us completed.. DOWNLOAD FORM

A simple questionnaire for Medicare recipients. . DOWNLOAD FORM

This form allows you to submit a complaint in writing to the clinic. Please mail it to the office at 3901 Pine Lake Rd, Ste 220 Lincoln, NE 68516 attention Gloria or HIPAA Compliance/Safety Officer. A staff member will follow up on the complaint. Complaints may also be called in to the clinic.  DOWNLOAD FORM