Patient Forms

If you are a New Patient, you can use our "New Patient Package" - a single PDF form that combines our Patient Demographics, Health History, and HIPAA forms into a single form that you can fill out on your computer and then print or submit via e-mail.  

 New Patient Package (digital) ** If you choose to submit your form via e-mail and do not receive an automated acknowledgement from us we ask that you print a copy of this form at home and bring it with you.

All forms are available to download as Adobe PDF files. If you do not have Adobe Acrobat PDF viewer, you can dowload it here.

Please download, print, and fill out the following patient forms. Bring them with you to your first appointment.

 Patient Demographics

 Health History

 HIPAA

If you have more than a few prescriptions, please list them on this form and bring it with you to your first appointment.

 Medication List

Doctor's Forms

If you are visiting Dr. Brown for a knee problem, please bring this form to your appointment:

 Dr. Brown's Knee Injury Questionnaire

If you are visiting Dr. Hutton for a shoulder problem, please bring this form to your appointment:

 Dr. Hutton's Shoulder Injury Questionnaire

If you are visiting Dr. Buzzell for a shoulder problem, please bring this form to your appointment:

 Dr. Buzzell's Shoulder Questionnaire

If you have scheduled a joint replacement surgery with Dr. Neumann, please fill out the respective form:

 Dr. Neumann's Knee Replacement Form

 Dr. Neumann's Hip Replacment Form

If you are visiting Dr. Arnold for a knee problem, please bring the following forms to your appointment:

         Dr. Arnold's Knee Evaluation form

         Dr. Arnold's Shoulder Injury Questionnaire

* Special Worker's Compensation Questionaire - Only use this form if specifically instructed.

           Work Comp Questions form2.pdf

Financial Documents

Financial Policy

Copay Information

If you would like to use Patient Notebook for online billing, please refer to the following forms:

 Patient Notebook Registration

 Patient Notebook Instructions

Medical Records

If you are requesting medical records for another doctor or facility, please download the following form and fax to Medical Records at 402-637-0858:

 Informed Consent for Disclosure of Patient Health Care Records

If you would like to fill out this form digitally and print it off to bring with you, please use this fillable PDF:

Informed Consent (digital)

2012 - Notice of Charges for Disability forms and Medical Records requests

 Disability and Records Notice 01.2012.pdf