• Consent to Treat MINOR

     

    Use this form if you are a legal parent or guardian and want your child to be able to be seen and treated without you being present.

     

  • Authorized Care Agent

    Use this form if you are a legal parent or guardian wanting to give another person(s) authority to bring your child in for care.

     

Downloadable Forms

Did you know that you can access your medical records via our online portal, Follow My Health?

 

Call us today to get set up or click to set up!

(308) 344-4110, option 7

  • Registration

    Form

    Print and complete this form prior to your appointment to save time when checking in.

  • Authorization to Release Records

    Use this form if you want McCook Clinic to get your records from another doctor.

  • Authorization to Release Records

    Use this form if you want McCook Clinic to send your records to another doctor or facility or if you need a copy for yourself (charges may apply).

  • Third Party Authorization

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

McCook Clinic, P.C.

1401 East H Street

McCook, NE 69001

For Life-Threatening Emergencies Call 911
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