Omaha Children's Clinic P.C. Communication Consent

Please correct the errors described below.

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Telephone Messages

Patient Portal: The patient portal is an optional service that allows parents/guardians to retrieve selected patient information and communicate directly with our staff. If you are interested in adding this feature for your family, please read the following information and sign this form, giving us consent to activate a portal for you.

  • We do not sell or give away any protected health or contact information. We reserve the right to suspend or terminate the Patient Portal account at any time and for any reason without notice.
  • Please note that the Patient Portal is not checked for messages on weekends or holidays.
  • By using the Patient Portal, you agree to protect your password from unauthorized individuals. It is your responsibility to notify us if your password gets lost or stolen, we will reactivate a new account for you.
  • You agree to not hold OCC responsible for any network infractions beyond our control.

Text Appointment Reminders: This is an automated text reminder of your child’s appointment 1-3 days in advance. This feature would replace the reminder calls you now receive. We require one cell phone number on file to enable this feature.


DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

I understand that this authorization for disclosure is in effect until I choose to have it revoked, and I may do so at any time.

Your information will be encrypted.

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