Patient Registration Packet (PDF)
Includes HIPAA Privacy Notice and Patient Rights & Responsibilities

Pre-Registration Paperwork (PDF)
Compete and bring with you to the office for your appointment

Election to Self Pay (PDF)

Bundled Surgical Package Disclaimer (PDF)

Advance Directives
An Advance Directive is a document that allows a person to give instructions about medical care should he or she be unable to participate in health care decisions due to serious illness or incapacity. The most common types of Advance Directives are Living Wills and Power of Attorney Forms for Healthcare. Both Living Wills and durable Powers of Attorney for Healthcare are recognized by Nebraska state law. If you have an Advance Directive please bring a copy with you the day of surgery. OSSC maintains the policy not to honor Advanced Directives in a life threatening emergency and will perform life saving techniques at that time. However, a copy of the form(s) will be transferred to the acute care facility with you in an event of a life threatening emergency. For more information, contact: Department of Health & Human Services – State Unit on Aging, P. O. Box 95026, Lincoln NE 68509-5026. Phone: 1-800-942-7830 or Fax: (402) 471-4619. The Living Will form can be found at:, and the Power of Attorney form at: