Preparing for Your Appointment

Prior to your scheduled appointment, our office staff will contact you to confirm your demographic and insurance information.

You will be reminded of your appointment at least 1 week prior to the appointment date either by text message, phone call, and/or email depending on your preference. Please confirm whether you will be attending your scheduled appointment or needing to reschedule.

We ask that you arrive 15 minutes prior to your scheduled appointment time to complete any necessary paperwork before your appointment.

If you are not already enrolled in MyChart, our office staff will assist you in completing your enrollment.

Co-pay and payments towards outstanding balances will be collected at the time of service.

Items you should bring to your appointment:

Photo ID
Insurance card(s)
Medication list or bottles – include dosage and frequency
Referral or authorization from your referring clinician (if required by your insurance)
Legal documents, such as Advance Directives or Power of Attorney for Healthcare (if applicable)

If you have any questions about your appointment or what to bring, please contact your specific NANI clinician’s office. We’re here to help!

NANI Appointment Request Form

Please complete all fields below

We provide comprehensive kidney care to all patients and support all languages, including American Sign Language (ASL), using our on-demand certified medical video translation system ensuring every patient can communicate comfortably.

Please note this request form is for non-urgent appointments. Our office will contact you within 2 business days of your submission. If you are experiencing a medical emergency or have an urgent need please call 911.

First Name

Last Name

Address

Date of Birth

City

State

Zip

Phone Number

Email Address

Primary Insurance (just the name)

Have you been seen by a nephrologist before?

If so, what was their name and when?

Who is your Primary Care Physician?

What is the name of the physician referring you?

How quickly does your referring physician recommend you be seen?

Is this an urgent/time-sensitive request (i.e. needing surgical clearance)?

What is the primary reason for the appointment request?

Is there a specific doctor or practice that you would like to be seen by?

What times of day do you prefer?

How quickly would you like to be seen?

When is a good time of day for us to contact you?

Message

The Largest Kidney Specialist Group in the U.S.

dedicated to your kidney health

Preparing for Your Appointment

NANI Appointment Request Form

Please complete all fields below