National Suicide Prevention Lifeline: 1-800-273-8255.
- For unresolved issues or suggestions regarding billing or an experience at BCHC please complete the following form.
- For help with your current bill, call 402-395-2191 and ask for Patient Financial Services.
- For help with a bill that is past due:
- If you got the bill before January 2, 2018, call 402-395-3268.
- If you got the bill after January 2, 2018, call 308-398-3955.
- For a loan to help pay off your medical bills, call Nancy at Cornerstone Bank 402-395-2151.
- Flu “Shot on the Spot” Forms
Sports Physical Registration
Title it Sports Physical Registration Form
Financial Assistance Application
Release of Health Information Form
Patient Service Agreement Clinic – Outpatients
Patient Service Agreement Clinic – Outpatients – Spanish
Patient Service Agreement
Patient Service Agreement – Spanish
2018 Community Health Needs Assessment
Patient/Visitor Grievance Form
Health Insurance Marketplace Authorization Form
Functional Needs Registry Information
Dispose of unused, unwanted, or expired medications