York Medical Clinic
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Forms with York Medical Clinic in York, NE

Patient Information Form.pdf
File Size: 89 kb
File Type: pdf
Download File

​Registration Form for New Patients- Print and complete this form prior to your appointment to save time when checking in.

Release to YMC.docx
File Size: 44 kb
File Type: docx
Download File

​Authorization to Release Records - Use this form if you want York Medical Clinic to get your records from another doctor.

Release from YMC.docx
File Size: 43 kb
File Type: docx
Download File

​Authorization to Release Records - Use this form if you want York Medical Clinic to send your records to another doctor or facility or if you need a copy for yourself (charges may apply.)

HIPPA.rtf
File Size: 86 kb
File Type: rtf
Download File

​HIPPA Form- Use this form if you want to give someone else access to your records. (ex. a child, a friend, your POA)

​York Medical Clinic, P.C. Family Medicine
2114 Lincoln Ave., Ste. A

York, Nebraska 68467
Phone: (402) 362-5555
Fax: (402) 362-6328

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Find our featured Clinic in Medical and Health featured as a York, Nebraska Business in York Marketplace.
Website by York News-Times
  • Home
  • Providers
  • Services
    • Quick Care
    • Insurance & Payments
  • Telehealth
  • Programs
    • Care Coordination
    • Diabetic Services
    • SERPA Accountable Care Organization
    • Health
  • FAQ's
  • Jobs
  • Forms
  • Contact Us