Midwest Nephrology - Online Forms
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Patient Information & Forms

Save yourself the time of filling out forms at the doctor's office by downloading the necessary forms below. Simply print them out, fill in the appropriate prompts, and bring them with you to your appointment.

You will need Adobe Acrobat Reader to view these forms. If you don't have Acrobat already, then visit the following link to Download Free Adobe Acrobat Reader.

New Patient Information - PDF Format
- Welcome
       - Financial policy
       - Lab policy
       - Procedure policy

Patient Forms - Adobe PDF Format
- Personal history
       - Health questionnaire
       - Patient registration

Patient Notice Of Privacy Practices - Adobe PDF Format


Patient No Show Policy - Adobe PDF Format


Dr. Khan's patient's health questionnaire - Adobe PDF


Patient Portal Available for Existing Patients

Click here to enter the patient portal

Payment Options

If you have questions about what or how much is covered by your private healthcare insurance, contact your plan provider, or provide us with your insurance information and we will check for you.

For your convenience we process all insurance claims for you. Please be prepared to provide up-to-date insurance information at each visit. We accept all major insurance providers.

We accept the following credit cards: