Patient Information > Online Patient Registration Forms

You may pre-register with our office by filling out our online Patient Registration Form. To begin your registration process, click the link below at the location you have scheduled your appointment. 

You may choose to Submit to the office or you may Print and bring it with you to your appointment. 

To Submit Online:
 
  1. Be sure that have Adobe Acrobat Reader 9 on your computer.
  2. If not, you may download the latest version of Adobe Reader below.
  3. After you have completed the form, press the Submit button at the bottom to automatically send us your information.

 ***If you can not type in the fields of the form or if you receive an error message after hitting the submit button, your computer does not have Adobe Acrobat Reader 9. You may either install the plug-in (link below) or print and bring with you to your first appointment.***

4. After hitting Submit, you should receive a confirmation page informing you that the information has been sent to our office.

5. On your first visit to our office, we will have your completed form available for your signature.

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. Please contact us with any questions.

Mac Users

You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site. The default application 'REVIEW' used to open PDF document's is NOT supported for this form.  You need to change your MAC settings to make sure the defualt application for viewing PDF documents is set to ADOBE READER.

PC Users

Our online form uses Adobe Acrobat Reader 9 or greater plug-in to conveniently submit the form. Please download the free plug-in from Adobe's web site if it is not already installed on your system.

  • Omaha Office 1
    Location: 144th & West Center
    Doctors: Dr. Bruce Kuhn, Dr. Harold Tu
  • Omaha Office 2
    Location: 132nd & Birch (West Maple Rd.)
    Doctors: Dr. Rudy Schneider, Dr. Robert Pfeifle
    PLEASE NOTE: 132nd from Erskine to Eagle Run Drive  is closed.
  • Omaha Office 3
    Location: 92nd & West Center
    Doctors: Dr. John Engel, Dr. Steve Coffey
  • Council Bluffs
    Location: 201 Ridge Street - The Doctors Building at Jennie Edmunson
    Doctors: Dr. David Marshall, Dr. John Andersen, Dr. Jim Heit, Dr. Bert Wood
  • Fremont Office
    Doctors: Dr. Steve Wendt
  • Norfolk Office
    Doctors: Dr. Greg Sears
  • Carroll Office
  • Atlantic Office