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New Patient Paperwork

for Christine Karell, APRN-BC  and Ana Cerrato-Young APRN-BC

INSTRUCTIONS
Everyone must complete the New Patient Packet. Please click here to fill out paperwork online at: https://intakeq.com/new/kkdpqu

 

Nebraska residents without insurance, that would like to qualify for our sliding fee scale, must complete the Region paperwork and bring required documentation listed with them on their first visit. Please be advised, required documentation must be present at first visit in order to continue with appointment. If documentation is not received in full, your appointment will be rescheduled. Some restrictions apply. Please call our office for more details. 

 

You may complete a Release of Information if you have a specific person or entity you want us to send or receive information to/from. For example, your primary care provider, school, or therapist.  

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For all other providers please contact our office and we will be happy to email, mail, or fax you new patient paperwork. 

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308-225-6572
Toll Free: 1-866-228-2636
Fax: 308-217-4277

815 Flack Ave, Alliance, NE 69301

1503 19th Ave, Scottsbluff, NE 69361
 

 
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Alliane Clinic hours:

Monday -  Thurs      8:00 am - 05:00 pm

closed for lunch 12:00pm to 1:00pm

Friday                       Closed
Saturday                  Closed
Sunday                     Closed

some appointments may be made by individual therapists outside theses hours

Mental Heath Alliance

© 2024 MHA, No animals were harmed in the making of this site.

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