Home Staff
Services
Location
Forms
Contact

 

 
Registration Forms

Registration Form

Financial Policy Form

HIPAA Privacy Form

Health History Form

Registrations forms are available to print out at your convenience prior to your first visit or to update your demographics and protected health information.

Click on the left to access the following forms:

Registration Form
Financial Policy Form
HIPAA Privacy Form
Health History Form

 




 

The Wellness Place | 818 Village Square, PO Box 527, Gretna, NE 68028
Home | Our Friendly Staff | Services | Location | Registration Forms | Contact Us

Business Hours: Monday-Friday 8-12pm & 1:00-5pm | Saturday 8-12pm