Forms

Patient Paperwork for Satellite Clinics ONLY

If your appointment is at our Main Lincoln Offices { 575 South 70th Street, Suite 200 (North Office) or 6900 A Street (South Office)} you’ll receive a text message or email to complete your paperwork. Please do not fill out this form. 

Liability Claims (Auto or Accident Information) 

Parental Authorization Form 

EMG/NCS Referral Form

Medical Records Request

Attestation Regarding a Requested Use or Disclosure of Protected Health Information Potentially Related to Reproductive Health

Good Faith Estimate

No Surprise Billing Disclosure Notice