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Pediatrics, P.C.
About Us
Our Story
Meet the Team
Our Services
Prenatal Visits
For Families
Forms
Tylenol and Ibuprofen Dosing
Parent Resources
Flu Vaccines
Car Seat Checks
Patient Services
Contact
Schedule a Visit
Visit Us
Klara Texting
☎ (402)489-0800
Pay My Bill
Pediatrics, P.C.
About Us
Our Story
Meet the Team
Our Services
Prenatal Visits
For Families
Forms
Tylenol and Ibuprofen Dosing
Parent Resources
Flu Vaccines
Car Seat Checks
Patient Services
Contact
Schedule a Visit
Visit Us
Klara Texting
☎ (402)489-0800
Pay My Bill
Folder: About Us
Back
Our Story
Meet the Team
Our Services
Prenatal Visits
Folder: For Families
Back
Forms
Tylenol and Ibuprofen Dosing
Parent Resources
Flu Vaccines
Car Seat Checks
Patient Services
Folder: Contact
Back
Schedule a Visit
Visit Us
Klara Texting
☎ (402)489-0800
Pay My Bill

Forms and Policies

For your convenience we have provided several of our forms for our families to download and print.  You may print the forms on white paper, complete them at home, and either fax them to (402) 489-6803 or bring them with you to your next appointment.


  • Patient Registration Form

  • Patient Registration Form (19yr and older)

  • Financial Policy Form

  • History Form

  • Release of Information Form (To Us)

  • Release of Information Form (From Us)

  • Adolescent Physical Form Kids Age 12 and up (Teens please fill out)

  • COVID Vaccine Consent Form

Forms (In Spanish)

  •  Registro de Paciente Nuevo

  • Registro de Paciente (19 años y mayor)

  • Poliza Financiera 

  • Historial

  • Autorizacion Para Compartir Informacion (A nuestra clinica) 

  • Autorizacion Para Compartir Informacion (A otra clinica)

    QUESTIONNAIRES

  • Abdominal Pain Questionnaire

  • Headache Questionnaire

  • ADHD Questionnaire

VACCINE POLICY

  • Vaccine Policy 

Vitamin K POLICY

  • Vitamin K Policy

TRANSLATION SERVICES

  • Translation Services

DISCRIMINATION POLICIES

  • Albanian

  • Arabic

  • Chinese

  • Dutch

  • English

  • Filipino

  • French

  • Japanese

  • Korean

  • Polish

  • Russian

  • Serb Croatian

  • Spanish

  • Ukrainian

  • Vietnamese

 

Pediatrics P.C.

7001 A Street, Suite 110
Lincoln, Nebraska 68510 

Phone: (402) 489-0800
Fax: (402) 489-6803

Hours

Monday-Thursday 8:30 am-5:30 pm
Friday 8:30 am-4:30 pm
Saturday 8:30 am - 12 pm