Patient Registration Form
Please download and fill-out our Patient Registration Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
- Download Our Patient Registration Form
- Download Our Financial Agreement
- Download Our HIPPA Consent Form
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Our office is located at: 1415 Harney Street, Suite 100, Omaha, NE.
- Get driving directions
- Meet Drs. Schrad and Polerecky
- Office Hours: Monday – Thursday from 7:00 AM until 5:00 PM and open alternating Fridays from 8:00 AM until 1:00 PM