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Call today(402) 291-3721

Open:Monday - Friday
and Some Saturdays

Dentist Bellevue NE Patient Information

Listed below are the forms given to our new patients. Please feel free to click the link below, print, sign and bring with you to your visit.

Health History
Financial Policy
No show/Cancellation Policy
Consent/HIPPA Policy

New Patient Paperwork

*Payment options available:

  • Cash
  • Visa, Mastercard, Discover, American Express
  • Checks


Most insurance accepted, as well as Nebraska Medicaid

Please bring your insurance card/ insurance information with you to your appointment. This helps to insure your dental claims go to the correct address.

*Cancellations/ No Shows

We know that your time is as important as ours. Dr. Stacey does his best to keep the costs affordable.  However, when appointments are cancelled at the last minute or patients do not show for the scheduled appointment,  it raises costs and eliminates the chance to schedule someone else at that given time. A 24 hour advance notice is appreciated if you are unable to keep your scheduled time. We want to keep our operating costs down and pass the savings on to you! 

Office Hours:
Monday: 7:30-6 pm
Wednesday 8-6 pm
Thursday 7:30-5 pm
Friday 8-5pm
Saturdays (1 per month) 7:30-12:30