New Patients

Patient Forms, Map and Directions 

Thank you for choosing Omaha Childrens Clinic as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease.  We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.

Mission Statement

Our practice is working together to build life-long relationships between our staff and patients by consistently providing our patients with compassion, excellence and value.

To fulfill this mission, we are committed to:

• Improving the lives of the children we serve by providing quality care in a child-centered environment.
• Listening to our young patients and their families who we are privileged to serve.
• Guiding our patients along a path of optimal health and wellness.
• Continually pursuing excellence at all levels through continuing education.

If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:

• Insurance cards
• Complete immunization records
• Medical records from your previous pediatrician

Patient Forms

We are happy to provide our office forms to fill out on your home computer conveniently. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.

New Patient Paperwork

• Delegation of Consent
• Omaha Childrens Clinic Communication Consent
• Omaha Childrens Clinic Financial Policy
• Patient Registration Form
• Child Custody Policy

Patient Forms

• 19+ Intake/Consent
• Attention Parents
• Authorization for Release of Information
• Immunization Statement
• Privacy Practices
• COVID-19 Vaccine Screening Form & Consent
• OCC Covid-19 Vaccine Information Sheet
• Pfizer-BioNTech Covid-19 Vaccine Information Sheet
• Dr. Roberts - New Patient Form

The Initial Visit

Our compassionate pediatricians do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all the important information about our practice available on our website, you can feel confident that you and your child are well-prepared for your first appointment. We also invite you to review our staff page to learn about our doctors and staff. 

We look forward to meeting you!