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
- Welcome
       - Financial policy
       - Lab policy
       - Procedure policy

Patient Forms Complete and print out forms and bring with you to your initial appointment.
       - Personal history
       - Health questionnaire
       - Patient registration
       - Patient Notice Of Privacy Practices


Patient No Show Policy


Dr. Khan's patient's health questionnaire


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: