Patient Forms

Please download, print and complete these forms and bring them with you to your first appointment.

Click on any image below to download an Adobe Reader® file of that form.


Child Health Summary
(birth - 9 years)

Adolescent Health Summary
(10 - 18 years)

Adult Health Summary
(19 years - up)

Patient Registration Form

Lifetime Consent Form

Notice of Privacy Practices

If you don’t have Adobe Reader on your computer, click here for a free download.




Shoal Creek Family Medicine & Allergy  •  816-781-4244
9784 N. Ash Ave., Kansas City, Missouri 64157