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New Patient Forms

NEW PATIENT FORMS FOR FIRST VISIT

Welcome to the Urology Cancer Center!

Below you will find the necessary New Patient Forms that need to be completed for your first visit. Each box below needs to be opened and the documents need to be: printed off, filled out to the best of your ability and brought with you for you first visit.

You also are welcome to wait until your first visit to obtain and fill these out in person.

If you have any questions feel free to call our office: 402-991-8468 and ask for Help!

Assignment of
Benefits

We utilize a unique team approach: Dr. Luke and his Clinical Team, Research Coordinators, Treatment Nurses, Pharmacy, Scheduling and Financial staff work simultaneously during a patient’s visit to ensure delivery of the most accurate, personalized, efficient and expert care.

Patient Family
History Document

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Medications and
Allergies

We understand the financial burdens cancer may cause a patient and their family. We have highly trained and compassionate staff when it comes helping you choose the most appropriate insurance plans and obtaining assistance to minimize your out- of-pocket costs.

HIPPA Information

We utilize a unique team approach: Dr. Luke and his Clinical Team, Research Coordinators, Treatment Nurses, Pharmacy, Scheduling and Financial staff work simultaneously during a patient’s visit to ensure delivery of the most accurate, personalized, efficient and expert care.

New Patient
Demographics

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Medical Records
Request Form

We understand the financial burdens cancer may cause a patient and their family. We have highly trained and compassionate staff when it comes helping you choose the most appropriate insurance plans and obtaining assistance to minimize your out- of-pocket costs.

Emergency Contact Info

We utilize a unique team approach: Dr. Luke and his Clinical Team, Research Coordinators, Treatment Nurses, Pharmacy, Scheduling and Financial staff work simultaneously during a patient’s visit to ensure delivery of the most accurate, personalized, efficient and expert care.

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We understand the financial burdens cancer may cause a patient and their family. We have highly trained and compassionate staff when it comes helping you choose the most appropriate insurance plans and obtaining assistance to minimize your out- of-pocket costs.

The Only Cancer Center in the US Exclusively Dedicated to the Treatment and Research or Prostate and Urological Cancers.

Your UCC Cancer Team brings all of the FDA approved standard of care treatments to the fight against your cancer.  However, more than ANY other cancer center in the U.S., the UCC Cancer Team has the most access to the latest cutting edge clinical research trials providing potentially life-saving treatments. Cancer research is the only way to discover and utilize new treatments for cancer patients. The Urology Center's Research Team is Globally recognized as a leader by scientific thought leaders, patients and pharmaceutical companies  Contact us today for the expert 2nd opinion that you deserve to see how we can bring the best fight against your cancer!

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Urology Cancer Center, PC

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Office Phone

402-991-8468

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GU Research Network, LLC

Office Phone

402-991-8468

Office Fax

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