Forms

Floyd Valley Healthcare makes your visit easy and comfortable. Click the links below to learn more about Floyd Valley Healthcare’s policies.

For more information on your visit, or if you have questions, call 712.546.7871

Clinic Pre-registration Form

Notice of Privacy, HIPAA, 1010, English

Notice of Privacy, HIPAA, 1010, Spanish

Echart Proxy, English

Echart Proxy, Spanish

Patient Information Release Form, HIPAA 1004, English

Obstetrics Pre-registration Form

Sports Physical Form

Patient Information Release Form, HIPAA 1004, Spanish

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714 Lincoln Street NE

 Le Mars, IA 51031

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