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.

Appointment Request Form
Prenatal Consult Request Form
Patient Portal
Online Bill Pay

Well child forms are now located on our patient portal. Click below to go to our portal.

Patient Portal

Medical History Form 3 Years and Older
Medical History Form Less than 3 Years Old
General Information Sheet

If you would like to request that another office send records to Complete Children’s Health please fill out the following form.

Authorization to Get Records Form

If you would like to request that Complete Children’s Health send copies of records please fill out the following form.

Authorization to Release Records Form

In addition, many of your child’s records are found on and/or can be requested through the patient portal.

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

New Patient Packet
Prenatal Packet

Asthma 1st Appointment Form (Spanish)
Asthma 1st Appointment Form
Asthma Follow Up Appointment Form (Spanish)
Asthma Follow Up Form

Initial Parent Vanderbilt Assessment
Follow Up Parent Vanderbilt Assessment
Initial Teacher Vanderbilt Assessment
Follow Up Teacher Vanderbilt Assessment
ADHD Follow Up Appointment Form
ADHD Initial Evaluation Form
Behavior Clinic Initial Evaluation Form
Behavior Clinic Follow Up Appointment Form

This form is specifically for use with appointments with our psychologists. You may download and print the form listed below and bring it to your appointment

New Psychology Patient Form
Release Psychology Records