General Information

Know Your Numbers

Consent Form

Flu ‘Shot on the Spot’

Flu shots are offered a variety of times for your convenience.

Sunday, Oct 29th from 11 am to 1 pm.  / During Know Your Numbers event / Monday – Thursday,  Oct 30 – Nov 16,   7 am to 4:30 pm.

  • Please print, complete, and bring the form below. (also available upon arrival)
  • $35 payment-bring your insurance card, cash, or check.
  • No Medicaid coverage is accepted.
  • Open to ages 3 and up.
  • Enter through the Kvam Room door (North entrance of BCHC)

If these hours don’t work call 402-395-3154.

Flu Vaccination Consent Form


The patient is responsible for ensuring their insurance plan covers services at Boone County Health Center. Patients can call the number on the back of their card for plan information. We recommend patients review their plan coverage annually. Even if changes have not been made to a plan, the plan itself can change what is covered.

Healthcare Rights

Advanced Directives
Patient Bill of Rights
Privacy Policy
Nondiscrimination Policy

Discrimination Public Notice

Patient Forms

Colonoscopy Instructions

Endoscopy (EGD) Instructions

Release of Health Information Form
Patient Service Agreement Clinic – Outpatients
Patient Service Agreement Clinic – Outpatients – Spanish
Patient Service Agreement
Patient Service Agreement – Spanish

HIPAA Contact Form


2021 Community Needs Assessment

2020 Community Needs Assessment

2017 Community Needs Assessment

2015 Community Needs Assessment

2012 Community Needs Assessment

Patient/Visitor Grievance Form
Health Insurance Marketplace Authorization Form
Functional Needs Registry Information
Dispose of unused, unwanted, or expired medications


Click here for Advance Care Planning Video (7-26-2023)

SHIP-Medicare Advantage Presentation video(9-28-2022)