4508 38th Street, Suite 133, Columbus, NE 68601
PHONE (402) 562-4700  |  TOLL FREE 1-877-263-3644

Medical Forms

Provided on our website are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form. If you cannot access the form, please click on the Adobe icon. This will allow you to download this software, providing access to the forms. Please bring the completed form(s) with you to your scheduled visit. This will help expedite the registration process. Thank you.

Financial / Charity Assistance Program

Below are resources for our Financial / Charity Assistance Program.

If you would like to request Financial Assistance, please click on Charity/Financial Assistance Application link below, print and complete the application. Return the completed form to our Patient Accounts Department, Columbus Community Hospital, 4600 38th St., Columbus, NE 68601. If you have any questions regarding these programs, please contact our Patient Accounts Department at 402-562-3159.

Financial/Charity Assistance Program »