Patient Forms — Prairie Dental Group

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Patient Forms

Adult History Form

Child History Form
New Patient Intake Form
Records Release Form
Financial Policy Form
HIPAA Form
Authorization to Release HIPAA
Language Assistance

6944 "A" Street, Suite "B"
(Northwest corner of 70th and "A")
Lincoln, NE 68510
(402) 483-7597

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Office Hours

Monday 8:00 - 4:00
Tuesday 8:00 - 4:00
Wednesday 8:00 - 4:00
Thursday 8:00 - 4:00
Friday-Sunday closed

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6944 "A" Street, Suite "B"
(Northwest Corner of 70th and "A")
Lincoln, NE 68510
(402) 483-7597

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OFFICE HOURS

Monday 8:30 - 4:00
Tuesday 8:30 - 4:00
Wednesday 8:30 - 4:00
Thursday 8:30 - 4:00
Friday-Sunday Closed

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