Printable forms for your convenience
If this is your first appointment with us, please print, fill out and bring with you the Patient Information Form. Filling this out in advance of your appointment may save you some time in our waiting room.
- Patient Information Form
- Patient Authorization for Disclosure of Protected Health Information
- Authorization for Examination and/or Treatment of a Minor
- Patient Authorization for Sharing Treatment/Billing Information with Family/Friends
- HIPAA Acknowledgement Form
- Aviso de Practicas de Privacidad
- Financial Policy and Consent to Treat
- Saline Medical Specialties Physical Consent
- Immunization Proxy Form
- Vaccine Information Statements
Immunization Record Information
Saline Medical Specialties participates in the Nebraska State Immunization Information System. You can use this system to print your own immunization records.