Menu
About
Open submenu
Providers
Services
Open submenu
Patients & Visitors
Open submenu
Contact
Open submenu
Patient Education
Careers
Pay a Bill
Patient Portal
Search
Close submenu
About
Blog
Leadership
History
Mission, Vision, & Values
Commitment To Excellence
Community Benefits
Accreditation
Quality, Safety, & Infection Prevention
Phelps Memorial Foundation
Service League Volunteers
Testimonials
Close submenu
Services
Cardiac Rehabilitation
Cardiopulmonary Services
Cardiovascular
Community Education
Open submenu
Diabetes Education
Diagnostic Imaging
ENT - Otolaryngology
Emergency Services
Open submenu
Gastroenterology
General Surgery
Immunization Clinic
Laboratory Services
Nutrition
Obstetrics
Open submenu
Oncology
Orthopedic Program
Open submenu
Outpatient Surgery
Pain Management
Phelps Medical Group
Open submenu
Podiatry
Psychiatry
Special Care Unit
Spine
Surgical Services
Therapy
Open submenu
Urology
Close submenu
Community Education
CPR Training Courses
Close submenu
Emergency Services
Emergency Room
Close submenu
Obstetrics
Childbirth Education Classes
Lactation Consultation
Close submenu
Orthopedic Program
Total Joint Camp
Close submenu
Phelps Medical Group
About
Open submenu
Contact
Close submenu
About
Patient Forms
Close submenu
Therapy
Occupational Therapy
Open submenu
Physical Therapy
Speech Therapy
Close submenu
Occupational Therapy
Pelvic Floor Therapy
Close submenu
Patients & Visitors
COVID-19 (Coronavirus)
Financial Assistance
Charge Estimator
Contact a Patient
Daisy Award
Schedule a Procedure
Billing and Insurance
Health Library
Patient Forms
Frequently Asked Questions
Language Resources
Parking Maps
Patient Navigator Program
Close submenu
Contact
Colorectal Kits
Vaccine Registry
Wellness
Skip to main content
1215 Tibbals Street, Holdrege, NE
308-995-2211
facebook-square
Top Bar Menu
Careers
Pay a Bill
Patient Portal
Search
Menu
Main navigation
About
Blog
Leadership
History
Mission, Vision, & Values
Commitment To Excellence
Community Benefits
Accreditation
Quality, Safety, & Infection Prevention
Phelps Memorial Foundation
Service League Volunteers
Testimonials
Providers
Services
Cardiac Rehabilitation
Cardiopulmonary Services
Cardiovascular
Community Education
CPR Training Courses
Diabetes Education
Diagnostic Imaging
ENT - Otolaryngology
Emergency Services
Emergency Room
Gastroenterology
General Surgery
Immunization Clinic
Laboratory Services
Nutrition
Obstetrics
Childbirth Education Classes
Lactation Consultation
Oncology
Orthopedic Program
Total Joint Camp
Outpatient Surgery
Pain Management
Phelps Medical Group
About
Patient Forms
Contact
Podiatry
Psychiatry
Special Care Unit
Spine
Surgical Services
Therapy
Occupational Therapy
Pelvic Floor Therapy
Physical Therapy
Speech Therapy
Urology
Patients & Visitors
COVID-19 (Coronavirus)
Financial Assistance
Charge Estimator
Contact a Patient
Daisy Award
Schedule a Procedure
Billing and Insurance
Health Library
Patient Forms
Frequently Asked Questions
Language Resources
Parking Maps
Patient Navigator Program
Contact
Colorectal Kits
Vaccine Registry
Wellness
Patient Education
Ortho Appointment Request
Back to top
You must have JavaScript enabled to use this form.
Patient Name
Phone Number
What hurts? Please select all that apply:
Elbow
Foot/Ankle
Knee
Hip
Hand/Wrist
Shoulder
Neck
Back/Spine
Other…
Enter other…
Please describe cause and symptoms below:
What type of insurance do you have?
Work Comp
VA
Self Pay
Auto
Other…
Enter other…
Availability Days
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
All of the above
Availability Times
Morning
Midday
Afternoon
All of the above
Close menu