We are pleased that you and your physician have chosen our facility.
Our goal is to make your registration as smooth as possible. To assist in this registration,
please download, complete and return the
pre-registration form [PDF] at least five days before your scheduled visit.
You may prefer to call us toll free or send by FAX machine your information. For
services in the Clarkson Tower the toll free number is 1-800-552-8802 or FAX to
402-552-3267. For services in the University Tower the toll free number is 1-800-552-8802
or FAX to 402-559-7866.
Please contact your insurance company before your hospital visit to meet any pre-authorization
requirements. If these requirements are not met, your benefits may be reduced, leaving
you responsible for paying most or all of your hospital expenses. Patients covered
by Medicare will also need to download and complete the Medicare Secondary Payer
Questionnaire [PDF], en español [PDF].
We appreciate your cooperation in assuring that this personal and insurance information
is up-to-date.
Unexpected medical expenses can be a financial burden. Do you think you may have
difficulty paying your bill? WE CAN HELP!
Financial assistance options are available. Would you like information about financial
assistance? If so, contact a Financial Counselor at 402-552-3251.
The Pre-Registration form requires the free Adobe Acrobat Reader®. Download the
free Adobe Reader.