Patient Forms

Required Patient Registration and Treatment Forms

Please download the forms below, print them out, fill them out, and bring to your first appointment at Nebraska Urgent Care.

Patient Health History and Registration Form

Consent for Treatment Form

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Nebraska Urgent Care is committed to providing safe access to healthcare during the COVID-19 pandemic. To keep you and our staff safe, we are keeping our lobbies empty, and ask that prior to coming to the clinic or when you arrive, you call the clinic at 402-470-6055 so that we may assess your situation before entering the building.  We also offer telehealth visits as an option that we can discuss when you call to see if this works for your situation.  Thanks for your business, and stay safe.