Registration Forms


Many patients prefer to fill out registration forms before they arrive. We believe this increases the accuracy of information the Doctor sees and provides a better outcome for your particular healthcare needs.

Take a moment to find your clinic or provider below and start filling out the registration forms right now. You can print the form and write in the information by hand if you choose. Or, for better results, fill out the form online and save it in a secure location. Print it and bring it with you on the day of your visit.



Forms for every patient to consider


These forms contain the typical questions you face when visiting a doctor's office. You will not need every piece of information for every visit, but we recommend keeping all the information up-to-date and easily accessible for when you do need it. The forms will help you keep track of:
  • Registration information like your name, address, insurance, emergency contact
  • Medical history like surgeries, allergies, family history of medical issues
  • Record of exams for heart rate, blood pressure, blood sugar, self-exam tests, and more
  • Dental visits, vision checks, ophthalmology appointments
  • Medication list of all current prescriptions, vitamins, supplements
  • Vaccination record of all shots received for immunizations

This "All-In-One Packet" combines the forms listed here into one easy-to-use document.



Inpatient - Assessment Forms


We currently have no additional online forms available for patients using our Inpatient Services. We encourage all patients to use the Forms for every patient listed above.



Outpatient - Specialty Clinic Forms


If you have an appointment with one of our Outpatient Specialty Clinics, these are the forms currently available for your visit. In addition to the "Forms for every patient" listed above, you should consider the questions on these forms before your visit. Providing the most accurate information to your Provider will help speed your recovery.


Nebraska Heart Institute
Dr. Nass
Dr. Rundlett



Rehabilitation - Assessment Forms


We currently have no additional online forms available for patients using our Rehabilitation Center Services. We encourage all patients to use the Forms for every patient listed above.



Ancillary - Assessment Forms


If you have an appointment with one of our Ancillary Departments, these are the forms currently available for your visit. In addition to the "Forms for every patient" listed above, you may be directed to consider the questions on these forms before your visit.


Radiology Department

Facility Hours:


24 hours a day
7 days a week
365 days a year


Contact Us:


Phone: (712) 382-1515
Fax: (712) 382-1503

Right Care. Right Here.


At George C. Grape Community Hospital, we understand that healthcare is evolving. Advancements in medicine and strides in technology are providing local communities access to better healthcare. It is our desire to provide the best care in our region. Our staff will be here to help you and your loved ones when the need arises. The comfort and care of our patients is our major goal.

Services are provided without regard to race, color, national origin, handicap, age, gender, religious affiliation, or socio-economic status. More details.