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FormsWBTheme2023-07-10T12:32:08-05:00

Patient Forms

(Forms can be downloaded and filled out in Adobe Acrobat.)

Authorization- Release of Records

Demographic Form

HIPAA

Medical History

Primary Care Partners New Patient Intake

Payment & Policies

Proud member of One Health Nebraska ACO for Medicare and Blue Cross Blue Shield. Comprehensive Primary Care Plus (CPC+) participating clinic.

WE ARE PCI DATA SECURITY COMPLIANT

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CONTACT US TODAY

  • 4130 Pioneer Woods Dr. Suite 2 Lincoln, NE 68506
  • 4424 S. 86th St. Lincoln, NE 68526
  • 402-483-2987
  • Office hours at all locations:
    • Monday–Thursday 7:00 am–7:00 pm
    • Friday 7:00 am–5:00 pm
    • Saturday 8:00 am–NOON (Saturday hours are for Urgent Care)
© 2020 PRIMARY CARE PARTNERS   |   ALL RIGHTS RESERVED
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