Forms & Policies
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
Patients with Medicare (only):
Medical Records Release
- Please arrive at least 15 minutes BEFORE your scheduled appointment time. This is to allow enough time to complete the registration and rooming process.
- Our providers make every effort to stay on schedule because we VALUE your time.
LATE / NO-SHOW POLICY
- If you are running late, please call us as soon as possible. We will then determine if we can make an adjustment to the schedule to see you. It is important to understand that a late arrival may result in an increased wait time for you.
- If you are not able to keep your appointment, please call us at 402-413-7460 at least 24 hours before your appointment time. A short notice cancellation does not allow us enough time to offer the appointment time to another patient.
- Patients who “No Show” will be billed $50.00 for the missed appointment time. The fee must be paid in full before another appointment can be scheduled.
- Patients who arrive more than 10 minutes PAST their appointment time will be considered a “No Show” and asked to reschedule.
- Appointments cancelled or rescheduled without a 24-hour notice will be considered a “No Show.”
- New patients who miss their first appointment will not be rescheduled until their Primary Care Provider conducts a peer-to-peer phone call with one of our Providers.
RETURNED CHECK POLICY
- If your check is returned for insufficient funds, you will be charged $30.00 per returned check.
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