Services

• New patients - complete the registration form below prior to appointment 
• Behavioral Health- complete the behavioral form below prior to appointment 
• Well Child Checks - complete the appropriate development form below prior to appointment
• Phone Nurse Triage
• Sick Visits
• Minor procedures
• Ear Piercing 
• Hospitalist Services at Columbus Community Hospital 

*****Forms completed electronically will be automatically and securely submitted to our clinic*****

Patient Consent and Authorization Form

• Patient Consent and Authorization 
• Patient Consent and Authorization - Spanish

Financial Responsibility Form

• Financial Responsibility 
• Financial responsibility form - Spanish

Notice of Health Information Privacy Practices & Acknowledgement of Receipt of Notice of Privacy Practices Form

• Notice of Health Information Privacy Practices & Acknowledgement of Receipt of Notice of Privacy Practices 
• Notice of Health Information Privacy Practices & Acknowledgement of Receipt of Notice of Privacy Practices - Spanish

Behavioral Health Clinic

The clinic offers behavioral health services with a Post-Doctoral Psychology Fellow from the Munroe-Meyer Institute of the Nebraska Medical Center. This service is for children and adolescents with a variety of behavioral, emotional, and developmental difficulties, and includes behavioral therapy as well as psychological assessment services. Appointments for this clinic can be made by calling Columbus Children's Healthcare at 402-564-7200 and selecting option 5.

Please complete the below demographics form before your appointment.

• Behavioral Health - English
• Behavioral Health - Spanish