online services
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 Form
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 Visit Questionnaires
2 Weeks Well Child Check
2 Months Well Child Check
4 Months Well Child Check
6 Months Well Child Check
9 Months Form 1 of 2 Well Child Check
9 Months Form 2 of 2 Well Child Developmental Screen (English)
12 Months Well Child Check
15 Months Well Child Check Screen (English)
18 Months Form 1 of 2 Well Child Check
18 Months Form 2 of 2 Well Child Developmental Screen (English)
2 Year Form 1 of 2 Well Child Check
2 Year Form 2 of 2 Well Child Developmental Screen (English)
30 Months Well Child Check
3 Year Well Child Check
4 Year Well Child Check
5-6 Years Well Child Check
7-8 Years Well Child Check
9-10 Years Well Child Check
11-12 Years PARENT Form Well Child Check
11-12 Years STUDENT Form Well Child Check
13-20 Years PARENT Form Well Child Check
13-20 Years STUDENT Form Well Child Check
Child with Special Healthcare Needs Form
Medical History Form
Dry Night Clinic Forms
Influenza Clinic Form
Medical Records
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.
New Patient Forms
If you have questions about the medical records process you can view our Frequently Asked Questions by clicking here.
Asthma Clinic Forms
Behavioral Forms
Initial ADHD Form
Follow Up ADHD 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
Developmental Form
Psychology Services 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
Additional Resources
LOCATIONS
3262 Salt Creek Circle, Lincoln, NE 68504
4020 Hohensee Drive, Lincoln, NE 68516
8201 Northwoods Drive, Lincoln, NE 68505
1336 West A St, Suite B Lincoln, NE 68522
Phone: 402-465-5600
Fax: 402-327-6074
HOURS
Office/Phone Hours
8:00 am to 5:00 pm Monday - Friday
9:30 am to 3:30 pm - Saturday
9:30 am to 1:30 pm - Sunday
Clinic Hours
8:45 to 4:30 Monday - Friday
Evening/Weekend Clinic Hours
West A Location Only
Sick visits only, appointments required
Monday - Thursday starting at 5:30
Saturday 9:00 am - 4:00 pm
Sunday 10:00 am - 2:00 pm