Columbus Otolaryngology Clinic

To Print These Instructions, Click Here...

1. Please make sure your printer is turned on and has enough paper (see below).
2. The Patient Registration Forms work best in a recent version of Adobe Acrobat Reader.  To download a free copy, click on the icon below...
Link to free download of Adobe Acrobat Reader
3. Select an appropriate option shown below and then click on the "Print" at top
(NOTE:  There will be a brief delay before printing starts.  Clicking on the "Print" button again will print the forms again.)

Option #1
Adults (Patients 19 and over) - Not due to Accident or Injury
(11 sheets of paper required)

Option #2
Adults (Patients 19 and over) - Due to Accident or Injury
(13 sheets of paper required)

Option #3
Minor (Patients 18 and under) - Not due to Accident or Injury
(11 sheets of paper required)

Option #4
Minor (Patients 18 and under) - Due to Accident or Injury
(13 sheets of paper required)

 

Columbus Otolaryngology Clinic

Nila M. Novotny, M.D.

 

 

4508 38th St., Suite #152

Columbus, NE 68601-1668

402-563-4500 FAX: 402-563-3520

After Hours/Emergency 402-562-3179

To Contact Us, Click Here...

Link to HIPAA Page of Columbus Otolaryngology ClinicLink to State of Nebraska HIPAA Web Site

Home Page Site Map Locations Novotny, M.D. Dicke, P.A.-C. Procedures Insurance Education

Link to Procedures Page of Columbus Otolaryngology Clinic

American Express, Visa, MasterCard & Discover Credit Cards Accepted

 

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