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Forms                                                                                       School Physical Forms
Medical & Personal History                                                  School/Sports Physical Form

     H&P #1                                                                                Kindergarten Physical Form

     H&P #2

Information Sheet

Payment Policy

Release of Information
Guardian Consent Form

Advance Directive

Insurance
Please bring your insurance cards with you for each visit so that we may take a copy for our records. This ensures that your claim will be submitted accurately which makes for speedier payment of your claim. There is no way for us to know whether or not your policy will cover a particular problem or service so please call your insurance company and review any questions you may have regarding your explanation of benefits with your insurance provider. If you have questions regarding the submission of your claim or what you may owe after your claim has been processed, please feel free to call our office.

 
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Norfolk Family Medicine | 900 W Norfolk Ave., Suite 100 | Norfolk, NE 68701 | (402) 371-2326