If you are coming to see us as a new patient, or are referring a patient to us for general consultation or dental or vision integrative services please download the appropriate forms below. If you are a new patient bring your forms to your initial evaluation. If you are referring a patient please fax the forms to us at 402-467-4580 or e-mail to us at firstname.lastname@example.org.
If you have questions about any of the paperwork. CONTACT US or ask the staff when you come to your initial visit.
If you are referring a patient to the Hruska Clinic for assitance with Dental Integration with a dentist please fill out this form prior to your patient coming to the Hruska Clinic.
If you are referring your patient to the Hruska Clinic for integration with our vision team we need this form filled out prior to the patient being scheduled with the vision team.