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Patient Forms
READY TO GET STARTED?
Two Simple Steps to Becoming a New Patient:
1. Book your appointment
2. Complete your forms below
Before You Book...
We accept most Blue Cross/Blue Shield, Cigna, and Aetna plans. We do not accept UMR/Optum, Medicare/Medicaid, or Tricare. Looking for self-pay rates or not sure if we’re a fit? See our Financial Policies Page, or call us at 402-252-3833 — we’re happy to help you check before you book.
Book Your Appointment Online
Select your state of residence below to schedule directly with your physician. All appointments are conducted via secure, HIPAA-compliant telehealth video.
Not sure which state applies to you? Contact us first and we'll guide you.
Now that you've booked, let's get your forms started.
All our forms are 100% HIPAA-compliant and securely hosted via JotForm. None of your responses are stored on this website, and all submissions are encrypted to protect your privacy.
Please complete the required forms (marked with an asterisk *) at least 5 business days before your appointment — appointments with incomplete forms will be cancelled to keep that time available for other patients. All other forms below are optional, though completing them helps your physician prepare for a more productive first visit.