402-465-5600

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.
APPOINTMENT GUIDELINES DURING COVID
Please select the location of your appointment and then review the information attached, before you arrive for your child’s appointment.

North location – 3262 Salt Creek Circle
South location – 4020 Hohensee Drive
East location – 8201 Northwoods Drive
West location – 1336 W A Street Suite B

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

Medical History Form
Medical History Form 3 Years and Older
Medical History Form Less than 3 Years Old
General Information Sheet
Well Child Visit Questionnaires
Well child forms are now located on our patient portal. Click below to go to our portal.

Behavioral Forms
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
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

New Psychology Patient Form
Release Psychology Records

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.

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.

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

Clinic Hours-Weekdays
8:45 am to 4:30 pm Monday – Friday

Clinic Hours-Weekends
Northwoods and West A Locations Only
9:00 am to 4:00 pm Saturday
10:00 am to 2:00 pm Sunday

Clinic Hours-Evenings
West A Location Only
Monday – Thursday starting at 5:30 pm

Phone Hours
8:00 am to 5:00 pm Monday – Friday
8:30 am to 3:30 pm Saturday
9:30 am to 1:30 pm Sunday

After hours - call 402-465-5600 and choose option 1 to reach Telephone Line to Care.

QUICK LINKS

Our Providers
Appointment Request
Symptom Checker
Pay Your Bill
Patient Portal
Terms Of Use

CONNECT

EMPLOYEE LINKS

Remote Access
Staff Email