COVID-19 – Effective Immediately

  • “No Visitor” Policy.  We will be allowing Only the Patient in the office for appointments and No Children. This also applies to our waiting area. The one exception is: 1 support person at your Ultrasound visit “Wear Face Covering”.
  • All Patients must Wear Face Coverings/Mask.
  • 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.

NWHC Patient Forms

You may complete our Patient Forms online and submit them securely to our office, or just print a copy of the completed forms (and not click the Submit button – and make sure you print before leaving your browser window, as your entries will not be saved.) and bring them to your next appointment.

New Patients

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

ButtonPatient Info Form

ButtonPatient History Form

ButtonNotice of Privacy Practices (read only)

ButtonAcknowledgement of Receipt of Notice of Privacy Practices

 


Established Patients

Please fill out the following online form yearly. 

ButtonEstablished Patient Info Form

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

ButtonEstablished 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.

ButtonPregnant Patient Package

ButtonBirth Defects Risk Assessment

ButtonDos and Don'ts in Pregnancy (read only)

ButtonScreening Options in Pregnancy (read only)

Northland Women's Health Care, P.C.
8380 N. Tullis Ave., Suite 300  •  Kansas City, MO 64158  •  Phone: 816-741-9122  •  Fax: 816-741-9665