Patient Registration Forms

Please call to schedule your appointment prior to submitting your forms. Completion of these forms without an appointment does not guarantee you will be able to be seen in our clinics. For more information and to schedule your appointment, please call us at 816.858.2412. Thank you for allowing Platte County Health Department to be a partner in your health.

Public Health Services Clinic 

• Flu Vaccine Registration Form
• TB Patient Registration Form
• Pregnancy Testing
• STD Patient Registration
• Immunization Consent and Registration Form
• Authorization and Consent to Immunize Form
• Immunization Record Request Form
• Insurance Card Upload
• Immunization Record Upload

Family Healthcare Clinic 

• Physical Examination Form
• Authorization for Release of Medical Information

COVID-19

• COVID-19 Vaccine Consent & Registration Form