Patient Forms

You will receive a link to complete forms online, if you are unable to complete them online you may print the forms below and bring with you to your appointment.

Please bring your INSURANCE CARDS and a PHOTO ID with you to all appointments.

Please arrive 15 minutes prior to your scheduled time.

Full Health History (Male)
Full Health History (Male)
Full Health History (Female)
Full Health History (Female)

No Surprise Act:

This Act went into effect on 1/1/22.

This includes Balance Billing and Good Faith Estimates for “non-insured” patients. Please see CMS for more information.

https://www.cms.gov/nosurprises‍

https://www.nebraskaneurosurgery.net/s/Notice-of-Privacy-Practices.docx