Pre-registration Form
First Name:
Gender:
 Male Female
Last Name:
Birth Date:
(dd/mm/yyyy)
Address 1:
Zip Code:
Address 2:
State:
City:
Home Phone:
 (###-###-####)
Email:
Cell Phone:
(###-###-####)
*Will you require medical services today?
Yes No
 
 

Pre-registration Form
Fit an appointment into your busy schedule and get priority over walk-ins by using our simple pre-registration feature.
If you need immediate treatment, please call ahead.

Information collected on this site will be held in the strictest of confidence and will be seen only by Urgent Care Clinic of Lincoln.

  

Office Hours
Open 7 days a week
Monday - Friday
8 am. to 8 pm.
Saturday - Sunday
10 am. to 6 pm.		 Office Location
4210 Pioneer Wood Dr.
Suite A
Lincoln, NE 68506
+ MAP on		 Multimedia
+ TV Spot
+ Billboard
+ Mailer
+ E-mmercial
Contact Information • 72nd & Pioneers, Lincoln, NE 68506 • Phone: 402-488-4321 • Fax: 402-488-4355 • info@ucclincoln.com