Patient Forms
Patient Forms
Release of Records Form
New Adult Patient Forms
New Pediatric Patient Forms
How to Complete Your Patient Forms
Download the PDF to your computer or device.
Open the file using Adobe Acrobat Reader (free) or another PDF editor. For the best experience, avoid filling out the form directly in your web browser.
Complete all required fields and save the completed PDF.
Attach the completed PDF to an email and send it to info@pinelakehealth.com with the subject line Completed Patient Forms.
If you are unable to complete the form electronically, you may print it, complete it by hand, and bring it to your appointment.
Need help? Please call our office and we’ll be happy to assist you.
Committed to Trusted Health Care
To reach the physician on call, (402) 423-4200 press 8 and your call will be forwarded to our answering service.