Colglazier Demmel
Medical Clinic

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These are the various forms you will need to register a new patient at the Colglazier Demmel Medical Clinic. Each one is available as a printable PDF file.

• Registration Form
• Registration Form
• Symptoms Form
• Authorization Form
• Privacy Policy
• Financial Policy

The links below constitute the Office Policies of the Colglazier Demmel Medical Clinic. Each one is available as a printable PDF file.

• Policies

Forms that include general health questions.

• Questionaire 1
• Questionaire 2

Diabetes questionaires and forms. Each one is available as a printable PDF file.

• Diabetes Questionaire
• Glucose Flow Chart
• Supplies-Insulin
• FreeStyle Glucometers
• Accuchek Glucometers
• One Touch Glucometers
• Bayer Glucometers
• DiabeticEdReferral
• DiabeticShoesScript
• GlucometerSupplyOrderForm
• Blood Sugar Log for Patients on Pills
• Blood Sugar Log for Patients on Insulin
• DiabetesRiskCanada
• Support Hose
• PulseOximetryNight

Sports Physical form. Each one is available as a printable PDF file.

• Sports Physical NE 2010
• Sports Physical Forms - Nebraska

Osteoporosis questionaires and forms. Each one is available as a printable PDF file.

• Osteoporosis Questionaire
• Osteoporosis

Immunization forms. Each one is available as a printable PDF file.

• Immunization
• Nebraska School Immunization Guide
• HHS Immunization Guide
• CDC Immunization Schedules
• CDC Travelors Guide

Each one is available as a printable PDF file.

• Grant
• Imperial
• Ogallala