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      Registration Forms

Registration Form

Financial Policy Form

HIPAA Privacy Form

Health History Form

Records Release Form
Registration forms are available to print out at your convenience prior to your first visit, or to update your demographics and protected health information. New patients must fill these forms out for their first visit.

Click on the left to access the following forms:

Registration Form
Financial Policy Form
HIPAA Privacy Form
Health History Form
Records Release Form

 




 

The Wellness Place | 818 Village Square, PO Box 527, Gretna, NE 68028
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Business Hours: Monday-Friday 8-12pm & 1:00-5pm | Saturday 8-12pm