Contact us

Set an appointment or contact your doctor directly through the Patient Portal. For all other inquiries or information, please call us at the numbers listed at the top of each page or in the footer.
Request an appointment today! (402) 441-3400

 

Contact us

Set an appointment or contact your doctor directly through the Patient Portal. For all other inquiries or new patient appointment requests, please call us at the numbers listed at the top of each page or in the footer.
Request an appointment today! (402) 441-3400

 

Online Patient Forms

Policies & Procedures

An introduction to Nebraska Internal Medicine’s patient policies and procedures. Click here  to open our PDF document for policies and procedures.

Patient Demographic
This form shows the new patient information demographics, as well as provides Nebraska Internal Medicine with insurance information and emergency contacts. Click here to open up the PDF form
Patient History
This form provides Nebraska Internal Medicine with vital patient history of hospitalizations, previous surgeries, medications, and reason for the appointment scheduled. Click here to open up the PDF form.
Family History
This grid formatted form will allow the patient to briefly show family history of several afflictions, diseases and chronic symptoms which may affect a patient’s treatment. Click here to open up the PDF form.
Release of Information
This form allows us to send or receive your medical information from other facilities or health care providers.  Please read and complete each selection carefully. Click here to open the PDF form.
Medicare Beneficiary Notification

This form is for the Medicare Shared Shared Savings Program.  Click here to open up a PDF Document of this form to print.

Better Health Care is Our Mission

402-441-3400

Call Us today

770 North Cotner Blvd

Lincoln, NE 68505

Hours: Mon - Friday

7:30am to 4:30pm

NEBRASKA INTERNAL MEDICINE PC