BCHHC

For your convenience, some common patient forms are now available online. 

Fillable format requires Adobe Acrobat. To download or learn more about free Adobe Acrobat software, please click here.

Using these forms electronically:

• Click on the document to open it.
• Save the form to your electronic device and fill it out.
• Complete the form and resave it.
• Attach the form to your email and send to: Bwccinfo@bchhc.org.
  • If you choose to print the form to fill out and want to return it by email, it must be scanned in. A photo of these documents cannot be accepted.
  • Please note: Emails sent from your personal device may not be encrypted. There are risks in sending and receiving Personal Health Information (PHI) unencrypted, such as the potential to be read by a third party. Your submission through email indicates your acceptance of associated risks.

Using these forms printed:

• Fill out the form.
• Print the form, and deliver to the clinic:
  • In person
  • By mail: Beatrice Women's & Children's Clinic, P.O. Box 278, Beatrice, NE 68310
  • Fax: 402-223-6565

A registration staff member will confirm receipt of the form for all methods. If you have any questions about this process, please contact the clinic: 402-228-3117 Ext. 1