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
Patient Information Sheet
Medical History Questionnaire
Notice of Privacy Practices
Patients with Medicare (only):
Medicare One Time Authorization
Medicare Secondary Payer Form
Medical Records Release
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.
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