COVID-19 – Effective Immediately

  • ”One Visitor” per patient (please limit to when absolutely necessary) and no children under age 14.  This also applies to our waiting area.
  • Masks continue to be required at our Clinic for patients and visitors.
  • Stay Home, if you are experiencing symptoms of COVID-19 and have reason to believe you have been exposed to COVID-19, and call our office for further information 816-741-9122.

Vaccine Info for Pregnant Women

NWHC Patient Forms

You may complete our Patient FormsButtononline and submit them securely to us

Or download a PDF version Acrobat Reader 9 icon of each form, complete it and bring it to your next appointment.

 

New Patients

Please fill out the following online forms prior to your appointment.

ButtonAcrobat Reader 9 icon  Patient Info Form

ButtonAcrobat Reader 9 icon  Patient History Form

ButtonNotice of Privacy Practices (read only)

ButtonAcrobat Reader 9 icon  Acknowledgement of Receipt of Notice of Privacy Practices

 


Established Patients

Please fill out the following online form yearly. 

ButtonAcrobat Reader 9 icon  Established Patient Info Form

If it has been more than 3 years, please fill out the following online form. 

ButtonAcrobat Reader 9 icon  Established Patient History Form


Pregnant Patients

If you are being seen in our office for your pregnancy, please complete the following forms in addition to either the New Patient or Established Patent Package.

ButtonAcrobat Reader 9 icon  Pregnant Patient Package

ButtonAcrobat Reader 9 icon  Birth Defects Risk Assessment

Button  Dos and Don'ts in Pregnancy (read only)

Button  Screening Options in Pregnancy (read only)

Northland Women's Health Care, P.C.
8600 NE 82nd St. •  Kansas City, MO 64158  •  Phone: 816-741-9122  •  Fax: 816-741-9665