Online Patient Registration Forms

Save time by pre-registering with our office!  To begin your registration process,  click on the link below at the location you have scheduled your appointment.

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.  This online patient registration is encrypted, secure and HIPAA compliant. 

If an unforeseen circumstance requires you to change or cancel your scheduled appointment,  we request 48 hours notice.

Please select the office link below where your appointment is scheduled.

1. OMAHA   Online Registration FormSpanish Online Form
     Location: 132nd & Birch (West Maple Rd.)
     Doctors: Dr. Robert Pfeifle, Dr. John EngelDr. Steve Coffey

2. COUNCIL BLUFFS   Online Registration Form / Spanish Online Form
     Location: 201 Ridge Street – The Doctors Building at Jennie Edmunson
     Doctors: Dr. David Marshall, Dr. John Andersen, Dr. Jim Heit, Dr. Adam Stanley
 
3. FREMONT    Online Registration Form / Spanish Online Form
     Location: 1437 East 23rd Street
     Doctors: Dr. Steve Wendt, Dr. Corey Auch
 
4. PAPILLION    Online Registration Form / Spanish Online Form

     Location:  1502 So. Washington Street
     Doctors:  Dr. Jim Heit, Dr. Adam Stanley

Information about our secure online patient registration form can be found here: 
https://pbhssupport.zendesk.com/hc/en-us/articles/200164224-TruForm-Classic-Security-Information.   Please contact us with any questions.