First, and most importantly, we would like to welcome you to Family Medical Center.

We appreciate the opportunity to help you and your family attain and maintain an active, healthy lifestyle.

 

So that we can serve you more quickly at your initial visit, please fill out the forms noted below prior to your visit. 

These forms can be filled out online (Adobe Reader version 8 or higher required) and printed off.  The forms can also be printed off and filled out by hand should you prefer to do so.  Please bring the completed forms with you to your first clinic visit or mail them to us prior to your scheduled visit.

 

Again, we would like to welcome you to our home!

Please note that none of the information entered on these forms will be saved. 

***Please print a copy of each form after it is completed to bring with you to your visit. 

We must have both forms signed prior to seeing you.

 

To return to this page from each form, be sure to use the “Back” button in your browser window, do not “Close” the window as it will close your internet session.

 

Adobe Reader version 8 or newer required to open forms below.

Policies below for information purposes only.

You may print these out for your records.

 

To return to this page from each form, be sure to use the “Back” button in your browser window, do not “Close” the window

 

Records Release Form (for all patients)

Additional Forms

Please fill out this form so what we may obtain your medical records from your previous physician

New Patient Information/Forms

Providing Inpatient and Outpatient Pediatric, Adult, and Geriatric care for you and your family

Family Medical Center

221 East 10th Street

PO Box 26

Ogallala, NE 69153-0026

 

 

Phone: 308.284.8421

Fax: 308.284.2821

Email: info@fammedcenter.com