Office Hours

Mon-Fri

7:00 am - 5:00 pm


Sat

8:00 am - 10:00 am


Sun

CLOSED


Walk-ins welcome if you need care right away!
Telephone No.(308) 344-4110

Printable Forms


Patient Registration Form- Please complete this form and bring it with you to your appointment with your insurance card.

 

The following forms can be filled out and brought into our office, faxed or mailed back to us.

Authorization Form 1 - Use this form if you would like McCook Clinic to send your records to another doctor, insurance company, individual or if you want a copy of records for yourself. All sections must be complete including the signature at the bottom. *There may be a charge for records released directly to the patient. Please call (308) 344-4110, option 7 with questions.

Authorization Form 2 - Use this form if you would like McCook Clinic to get your records from your previous doctor. All sections must be complete including the signature at the bottom.

Third Party Access - Use this form if you would like to give someone else access to your medical records or allow them to have access to your records on our online portal. Up to 4 people can be designated to receive access on one form. All sections must be complete including the signature at the bottom.