Patient Forms

We welcome all new and returning patients to Midwest Dermatology!  For your convenience, we have added a few of our patient forms to this site.

NEW PATIENT REGISTRATION

If you are seeing Dr. Jason Papenfuss, Dr. Justin Madson, or Dr. Melissa Darling, we have replaced forms with registration through the patient portal.  Simply click  here to get started.  You will be prompted to enter your user name and password.  For assistance logging in, contact our office at (402) 552-2555.

If you are seeing Dr. John Luckasen you will need to complete several registration forms.  This registration process is made easier by completing our forms in advance and bringing them with you to your appointment.   Please click on the links below and download each of these forms, print, fill out and sign.  Present the completed forms to the receptionist on the day of your appointment.

1.  Patient Intake Form

2.  Confidentiality Policy and Insurance Authorization

3.  Consent to Treat Minors (if applicable)

Thank you for helping us to speed up your check in by completing your registration in advance. We look forward to seeing you in the office.