Forms

Clinic Forms

Sports Physicals vs. Annual Physicals

You may wish to choose a more comprehensive annual physical for this appointment. See details to help you make your decision before scheduling your child's appointment. Parents must still complete the Sports Physical Form prior to both the annual and sports physical appointment. If you choose an ANNUAL physical instead it is more comprehensive and may be covered 100% by your insurance. Please call us with any questions at 308-282-1442.

Sports Physicals

Forms and consent MUST be completed by parent or guardians PRIOR to appointment. Please also check out the letter comparing annual vs. sports physical to evaluate your potential cost savings and more comprehensive appointment. Schedule your sports physical appointment for $25. If you choose an annual physical it may be covered under insurance.

Immunizations

Families and individuals can use the link below to view and print thier Nebraska Immunizations on the Nebraska Department of Health and Human Services (DHHS) website. To access this information, you will need the individuals first name, last name, date of birth, and social security number.

New Patients

Welcome! We appreciate you choosing Gordon Memorial Hospital District and are excited to serve you and your family! Please complete the following form prior to your appointment, or we can provide one at your visit. Do not hesitate to contact us at 308-282-0401 with any questions or concerns.