Forms & Policies 

Patient Forms

If you do not have access to your patient portal, you can download and print the registration forms and complete them before your appointment.

Patient Registration Forms 

Patient Information Sheet 

Medical History Questionnaire 

Notice of Privacy Practices

Consent to Treat Minor

Patients with Medicare (only):

Medicare One Time Authorization 

Medicare Secondary Payer Form 

Medical Records Release

Medical Records Request Form

Policies

LATE / NO-SHOW POLICY

Please respect our other patients by arriving at least 15 minutes before your scheduled time. If you arrive more than 10 minutes past your appointment time, you may be considered a “No Show” and be asked to reschedule. Our providers make every effort to stay on schedule because we value your time.

If you are not able to keep your appointment, please call us at 402-413-7460 at least 24 hours before your appointment time to avoid being charged a late fee.

Medical Records

If you need access to records that are not available on your patient portal, please
print and complete the medical records request form and fax or mail it to:

Dermatology Associates of Lincoln
6969 South Street
Lincoln, NE 68506
Fax: 402-413-7486

LOCATION

Dermatology Associates of Lincoln
6969 South Street
Lincoln, NE 68506
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Hours

Clinic Hours
M/W/TH/F: 8am–4:30pm
Tuesday: 7am–4:30pm

Phone Hours
M/W/TH/F: 8am–5pm
Tuesday: 7am–5pm