New Patients
Thank you for your interest in services at HelpCare Clinic. We are honored to partner with you in your time of need. Be sure you have reviewed our patient qualifications and have spoken with a staff member from HelpCare before going any further with our New Patient Paperwork.
To speak to someone at HelpCare Clinic, call (308) 224-2392.
For Emergencies: Call 911 or Visit the ER
New Patient Paperwork
Download our New Patient Paperwork here. You can print this form and fill it out on your own – but please remember to sign the form where it is required. Please return the completed form to HelpCare Clinic at 3015 Avenue A in Kearney (diagonal across the street from the ER at Good Samaritan Hospital). We need this completed paperwork BEFORE we can set up an appointment for you.
Please keep privacy in mind when returning this form. When completed, it has your personal information on it. Do not email the completed form back to us.
To return this completed form:
- Drop it off to a staff member at HelpCare Clinic during regular business hours.
- Drop it off in the secured mailbox near the front door at HelpCare Clinic.
- Mail the form to HelpCare Clinic at 3015 Avenue A, Kearney NE 68847.
- Fax the form to HelpCare Clinic at (308) 224-2399.
Do you qualify for HelpCare?