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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 816-587-5998. Thank you for allowing Platte County Health Department to be a partner in your health.

Public Health Services Clinic 

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