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Please click on the icons below to download an Adobe Reader® file of each form. Print, fill out and bring the forms with you to your next appointment.

Patient Information Form
Patient Information Form
General Consent for Treatment
General Consent for Treatment
Immunization Policy
Immunization Policy
Record Request Form
Record Request Form
PhysicalForm
State of Missouri
Physical Form
Notice of Privacy Practices
Notice of Privacy Practices


Platte County Pediatrics

1104 Platte Falls Road  •  Platte City, Missouri 64079  •  816-858-5253  •  Fax 816-858-5205