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Patient Portal
Contact Us
402-334-4773
Get To Know Us
Get To Know Us
What is Community Oncology
Choosing Your Provider
Physicians
Advanced Practice Providers
Nurse Case Managers
NCS Timeline
Patients
Patients
Your First Visit to NCS
New Patient Forms
Insurance and Financial Services
Locations
Managing Side Effects
Services
Services
Medical Oncology
Radiation Oncology
Nuclear Oncology
Hematology
Imaging
Occupational Therapy
Nutrition Services
Mental Health
Pharmacy
Genetic Counseling
Clinical Research Trials
Dignicap®
Tumor Profiling
PSMA
Movement for Longevity
Supportive Care Clinic
Resources
Resources
Healthy U
Peer Mentor Program
NCS Focus Magazine
Education
Podcasts
NCS in the News
Support Organizations
NCS Hope Foundation
For Providers
Careers
SEARCH
Referral Form
Patient Profile
Today's Date
MM slash DD slash YYYY
Patient First Name
(Required)
Patient Last Name
(Required)
DOB
MM slash DD slash YYYY
Patient Phone Number
Patient is aware of referral
Yes
No
Interpreter Needed
Yes
No
Language
Referring Provider Information
Referring Provider Email
(Required)
Referring Provider
Phone
Fax
Primary Care Provider
Phone
Fax
Reason for Consult
Nebraska Cancer Specialists Physician
or
First Available
First Available
Patient Records
Records available in
Epic
Cerner
Nehii
Other Health System
Other Health System
Please fax or email the following to 402-393-2161 or
newpatient@nebraskacancer.com
:
Progress notes from the last two years
Diagnostic Reports (CT, US, MRI, X-Ray) from the last two years
Labs from the last five years
Pathology Reports from the last two years
Please attach demographics
(Required)
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Max. file size: 500 MB.
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