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  Make An Appointment - Lozier       Print
Please note: This Alegent Health Clinic is only for Lozier employees and their faimilies.

ACUTE ILLNESS
For acute illnesses that are not of an emergency nature, call the clinic at (402) 457-8088 to schedule your appointment. Online appointment requests are for routine visits only.

IN CASE OF EMERGENCY
Online appointment requests are NOT to be used in the case of an emergency. The email box is not monitored after clinic hours. If this is an emergency, (for example, you are having chest pain), call 911 or go to the nearest Emergency Department.

PRIVACY INFORMATION
In order for you to submit an online request for an appointment, you may need to provide confidential medical information. By providing the requested demographic and medical information, you are authorizing the use of such information by Alegent Health.

INTERNET E-MAIL IS NOT SECURE.
Please be aware that the confidentiality of the information you provide through Internet e-mail is not guaranteed, and the information may be subject to interception by an outside party without the knowledge of Alegent Health. Consequently, if you do not wish to transmit the information included in the following form electronically, please telephone the clinic at (402) 453-9900 to request an appointment.

The information you provide will not be used for any other purpose than to schedule this appointment, and will not be shared with or sold to any other organizations, and tracers will not be used to collect information or track your computer use

NOTICE OF PRIVACY PRACTICES
The Alegent Health Notice of Privacy Practices may be accessed at this link.
In order to complete your request, you must acknowledge receipt of this notice in the form below.
Acknowledge Receipt: No Yes

* required info
CONTACT INFORMATION
Contact name *
Contact e-mail address *
Contact phone number *
How should we contact you to verify the appointment? *
Best time to reach you *
PATIENT INFORMATION
First name & middle initial *
Last name *
Gender *
Date of birth *
Street address *
Apartment or suite no.
City *
State *
Zip
Date patient last seen in this office *
Patient's primary physician
Who is appointment for *
Reason for appointment *
If reason for appointment is other state reason here
FIRST CHOICE
Preferred day for appointment *
Preferred time for appointment *
SECOND CHOICE
Preferred day for appointment
Preferred time for appointment
 
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Alegent Health is a faith-based, health ministry sponsored by Catholic Health Initiatives and Immanuel Health Systems.
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