Practice Forms

On this page we have included the forms that are required for some office visits. Our office staff will let you know if any of these are necessary. You may print them, fill them out, and bring them to the visit. This will help your visit to run more smoothly.

Online Forms

Use our online patient forms for non-urgent requests only.  For urgent requests, within 24 hours, please contact us by phone at 402-465-5600. Our office will contact you within 48 hours after receiving your online submission.


Downloadable Forms and Packets

To view the forms listed below, you will need Adobe Reader. You may download and print any of the forms listed below before coming to our office. You may either bring them with you to your visit, mail them, or fax them to us at 402-327-6074 before your appointment.

You may download Adobe Reader for free at Adobe icon

Practice Forms

If you have questions about the medical records process you can view our Frequently Asked Questions by clicking here.



Medical Record Forms

Come back soon!  

Medical History Form


Asthma Clinic Forms


Behavior Clinic Forms

with Dr. Akhtar Niazi

Behavioral Forms


      Dry Nights Clinic Forms


Developmental Form


Influenza Clinic Form


Psychology Services Form

This form is specifically for use with appointments with our psychologists. You may download and print the form listed below before coming to our office. You may either bring it with you to your visit or fax it to us at 402-327-6093 before your appointment.

Well Child Appointment / Physical Appointment Forms/Questionnaires



Practice Policies

You can view our practice policies on our Practice Policies page .

Frequently Asked Questions

Have more questions? Click to get the answers on our Frequently Asked Questions page.