Patient Forms

For your first visit please complete all four forms below. This is needed so that we may open a medical chart for you. Please complete your information online using the links below. You can also print out the forms to then complete them and either fax them to 402-465-9011, mail them, or bring them to the clinic prior to your appointment so that your medical record will be ready for your visit.

» Patient Registration

Online Patient Registration
Printable Patient Registration

» HIPAA Form*

Online HIPPA Form
Printable HIPPA Form
*Complete only if not previously signed or you wish to change

» Insurance Procedures

Online Insurance Procedures Form
Printable Insurance Procedures Form

» Patient History**

Online Patient History Form
Printable Patient History Form
**DO NOT COMPLETE IF NURSE CALLS YOU FOR A PROCEDURE AS NURSE WILL COMPLETE. If for a consult and not seen in 3 years, please complete.

When you arrive for your appointment please bring your insurance card, a referral (if required) from your primary care physician, and additional test results or pertinent medical records. We also suggest that you arrive 20 minutes early for your scheduled office appointment and 30 minutes early for your procedure at Lincoln Endoscopy Center.

For follow-up appointments you do not need to complete any additional forms.

For procedures or have not been seen in 3 years as an existing patient, please complete the history and physical form.
If the nurse has called you and taken the information, do not complete the form online.

All of this will hopefully lead to a prompt and stress-free first visit with us. We look forward to providing you and your family with the highest quality medical care in a professional setting. If you have additional questions call 402-465-4545.