New Patients

We want to take this opportunity to welcome you to our practice and thank you for choosing us to provide your dermatology health care. We appreciate your trust in us and look forward to working with you.

Enclosed you will find registration forms that we ask you to complete prior to your visit here. In order to provide the highest quality of care, please complete them as accurately as you can. If you have used any creams, lotions or prescriptions for your skin problems we ask that you bring a list of those with you. If you have been seen at another office for the same problem please bring those notes with you also.

Please bring the following with you on the day of your appointment:

  • COMPLETED forms enclosed (we will scan your insurance info)
  • ALL insurance cards
  • Current Medication list
  • Photo ID (for security purposes)
  • COPAY (if required by your insurance)
  • Guardianship papers if applicable
  • POA Paperwork if applicable

*** PLEASE NOTE THAT ALL MINORS WILL NEED TO BE ACCOMPANIED WITH THEIR PARENT/GUARDIAN***

New Patient Registration Form
New Patient Medical History Form
Medical Record Release Form
Medical History – Pediatric

Other Forms
HIPAA Notice of Privacy
Payment Policy Form

Location
Greater Nebraska Dermatology Clinic
2509 Halligan Dr., Suite E
North Platte, NE 69101
Phone: 308-313-3343
Fax: 308-532-4605
Office Hours

Get in touch

308-313-3343