Miscellaneous Forms
Request for Transfer of Medical Records
IUD and Nexplanon prior authorization instructions
IUD and Nexplanon prior authorization instructions
| health_release.pdf |
| larc_pt_insurance_instructions.pdf |
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.
| pvwhc_registration[1265].pdf |
School Physical Form
A Parent must complete this form prior to the school physical exam.
| preparticipation-physical-exam-form.pdf |
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.
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.
Student Application for Clinical Experience
| student_clinical_application.pdf |
