- About Us
KVC Nebraska is a private, nonprofit organization that provides a variety of programs and services to meet the diverse needs of Nebraskans.
Our mission is to enrich and enhance the lives of Nebraska youth, individuals and families.
We offer a variety of programs and services to meet the diverse needs of children, youth, adults and families. We accept referrals from the State of Nebraska Department of Health and Human Services, Nebraska Juvenile Probation, and parents and caregivers.
KVC Nebraska provides a variety of resources to help educate the community about child welfare, foster parenting, caring for individuals with disabilities, healthy brain development and more.
Caregiver Document Library
Foster Care and Foster Parent Forms
These forms are for current KVC Nebraska foster parents only and are NOT part of the Outpatient Therapy Intake Paperwork.
Outpatient Therapy Intake Forms
If you are a new Outpatient Therapy client, please fill out all forms below.* Please call 402-880-4926 if you have questions.
*It is required that the caregiver participating in services call 402-880-4926 to begin services. Filling out these forms alone does not constitute a referral for services.
- Informed Consent (Note: Includes Grievance Policy, Client Rights and Responsibilities, and HIPAA Notice of Privacy Practices.)
- Insurance Form
- Emergency Contact Authorization Form
- PCP Communication Authorization Form
- Telehealth Consent
Outpatient Therapy Assessment Forms
The forms below are for existing patients only, and will be filled out with the therapist. New patients, please disregard these forms. Please call 402-880-4926 if you have questions.