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Platte Valley Women's Healthcare & Mental Health Services
308-534-0090

Miscellaneous Forms

Request for Transfer of Medical Records
health_release.pdf
File Size: 29 kb
File Type: pdf
Download File

Visit Forms

Please print and complete the attached Registration Forms prior to your first visit with our clinic.  Please bring these completed forms to your first visit.  The HIPAA notice of Privacy Practices is available for your own information.  Please review this prior to signing your Registration Forms.
registrationform_11-11-17.pdf
File Size: 278 kb
File Type: pdf
Download File

School Physical Form

A Parent must complete this form prior to the school physical exam.
preparticipation-physical-exam-form.pdf
File Size: 46 kb
File Type: pdf
Download File

MyChart Patient Portal

Click on this link to register for the patient portal, or to access your personal portal (if already registered).  Call Alicia at 308-534-0090 if questions regarding registration or access to the patient portal.
MyChart patient portal

Subscribe to our mailing list

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Email Format

Student Application for Clinical Experience

student_clinical_application.pdf
File Size: 155 kb
File Type: pdf
Download File

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Platte Valley Women's Healthcare, PC &
Mental Health Services
810 W. Reid Ave. Suites 2 & 4
North Platte, NE  69101
Phone:  308-534-0090
Fax:  308-534-0091
www.PlatteValleyWomensHealthcare.com