Forms & Links

NEW PATIENT PAPERWORK Electronic Forms (Fillable PDF)

For NEW patients over 19 years old, please complete the following paperwork prior to your appointment:

New Patient Packet (required office paperwork for all new patients)

Telehealth Consent

For NEW patients under 19 years old, please complete the following paperwork prior to your appointment:

New Patient Packet (required office paperwork for all new patients)

Telehealth Consent

 

IN ADDITION TO THE ABOVE: For patients seeing Lindsey Teten, APRN, please complete a release for your primary care provider: 

Auburn Family Health

Nebraska City Medical Clinic

Syracuse Area Health

All other primary care provider, please complete this blank release.

EXISTING PATIENT PAPERWORK 

For EXISTING patients over 19 years old, please complete the following paperwork:

If using computer: Updated Demographics and Office Policies 

For EXISTING patients under 19 years old, please complete the following paperwork:

If using computer: Updated Demographics and Office Policies 

Minor Consent 

 

If using smartphone: Updated Demographics and Office Policies 

If using smartphone: Updated Demographics and Office Policies 

Minor Consent 

IN ADDITION TO THE ABOVE: For patients seeing Lindsey Teten, APRN, please complete a release for your primary care provider: 

Auburn Family Health

(Smartphone format)

Nebraska City Medical Clinic

(Smartphone format)

Syracuse Area Health

(Smartphone format)

All other providers, please complete this blank release.

(Smartphone format)

Download & Print Forms
 
Billing/Payment Forms