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 the registration desk to request your medical record number.  If you have any questions or problems with the online payment portal please contact us at (308) 697-3329 or patientportal@trivalleyhealth.com

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 308-697-4918 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 308-697-3329 Monday through Friday 8 a.m.-5 p.m. and request the Medical Records Department.

​​Patient Forms

Patient Family Questionnaire

Patient Family Questionnaire (Large Print)

Medicare Wellness Questionnaire

Medical History

Walk-In Clinic Intake Form

Health History Form

Release/Permission for Treatment of a Minor

DOT Physical 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.