Thank you for choosing Alegent Health Psychiatric Associates. We look forward to working with you to meet your needs.
Attached you will find the Clinic registration paperwork that need will need to be completed in order for the Clinic Staff and our Billing Office to effectively support your during your treatment. Please feel free to contact us with any questions that you may run into while completing our registration paperwork, or you can always stop in to any of your Psychiatric Associates Clinics to address any concerns in person.
Please print out and complete all the pages thoroughly and to the best of your ability.
- New Patient Information Sheet
Fill out completely, including the insurance information.
- Medical History Form
All sections must be completed.
- Medical Records Disclosure of Information
This form allows your provider to release your information to your primary care physician about your care. Please complete the top portion of the form with the requested information. Please write the name, address, phone and fax number of your primary care physician in the space provided, and sign the bottom.
- Medicare Secondary Payer Questionnaire
This form is required to be signed by all patients who have primary or secondary Medicare coverage.
- GAIN Short Screen
We have several locations throughout the Omaha and Council Bluffs metro and surrounding communities so please refer to the locations directory to find the clinic closest to you. Upon completion of your paperwork or for any questions or concerns that you may have please contact the appropriate Psychiatric Associates Clinic directly so that we can assist in addressing your concerns and setting up your initial appointment. Please arrive 30 minutes early for your appointment and bring your current insurance card.
For Substance Abuse Evaluations
Clients requesting a Substance Abuse Evaluation will need to call one of the following Psychiatric Associates outpatient clinics so the staff can personally assist with the registration process. This will ensure the privacy of your highly confidential information. Substance abuse services are located at the following clinics:
Alegent Creighton Health Psychiatric Associates Bellevue
3308 Samson Way
Bellevue, NE 68123
Phone: (402) 717-7681
Alegent Creighton Health Psychiatric Associates Council Bluffs - Harmony Street
801 Harmony Street, Suite 302
Council Bluffs, IA 51503
Phone: (712) 328-2609
Alegent Creighton Health Psychiatric Associates Immanuel
7101 Newport Avenue (Ike Friedman Center) STE 305
Omaha, NE 68152
Phone: (402) 572-2916
Alegent Creighton Health Psychiatric Associates Lakeside
16909 Lakeside Hills Court, Suite 400
Omaha, NE 68130
Phone: (402) 758-5850