To enhance your experience with Tri Valley Health System we have provided online patient resources to provide information about our programs, make online payments and request copies of your medical records.

To book an appointment, please contact us at 308-697-3329.

 

 

​Online Payments

If this is your first time accessing the online payment portal, please contact us at (308) 697-1165 and ensure we have your email address on file.  If you have questions about payment processing on the portal after you are enrolled please contact us at (308) 697-3155 or [email protected]

Requesting Copies of Your Medical Records

To request copies of your medical records from Tri Valley Health System you may print the Release of Information form, complete it, and fax it to 308-697-4176 or mail to:

Tri Valley Health System 
Health Information Management
PO Box 488
Cambridge, NE 69022

If you have questions or would like a copy of the authorization form mailed to you, please call 308-697-1165 Monday through Friday 8 a.m.-5 p.m. and request the Medical Records Department.

​​Patient Forms

Allergy Consult

    Patient Family Questionnaire

    Medical History

Medicare Wellness Questionnaire

​Walk-In Clinic Intake Form

Health History Form

Release/Permission for Treatment of a Minor

DOT Physical Form

ROI Authorization Form

NSAA Physical Evaluation Form

Nebraska School Activities Association (NSAA) Preparticipation Physical Evaluation (Note: This form is to be filled out by the patient and parent prior to seeing the provider.)

 

Privacy Policy

Tri Valley Health System's full Notice of Privacy Practices. 

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