• STD Patient Registration

  • Patient Information

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  • Insurance Information

  • I hereby grant permission to the Platte County Health Department to obtain speciments and to perform tests for sexually transmitted diseases. I also understand that I may be required to give identifying information, such as my Social Security Number, to the nurse when receiving results over the phone. I freely accept the medical and laboratory services provided to me. I am fully aware that all positive test results will be reported to the Missouri Department of Health and if HIV positive or TB positive, I will be offered management services. I also acknowledge that Platte County Health Department has offered me a copy of their "Notices of Privacy Practices".

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  • Sexual History Questionnaire

  • Please take a few minutes to fill out these questions about your sexual health. Your information is strictly confidential. This form will be shared with no one but your health care provider. Your honest answers will help your provider to privde the best care possible and work with you to help you be healthy.

  • When was the last time you had one of these diseases?      

  • IMPORTANT

  • The following STD testing is available in our Public Health Clinic:

    Platte County Residents qualify for free testing on Fridays (excluding Herpes testing).

  • WE DO NOT TEST for the following:

    • Trichomonas
    • Bacterial Vaginosis
    • HPV
    • Yeast Infections
    • We DO NOT do any exams in the Public Health Clinic. If you are concerned about a lesion, rash, or any of the above mentioned, you will need to make an appointment with a provider for an exam. Depending on your insurance status, you may qualify to see one of our nurse practitioners. Please discuss this with your nurse.
    • Please DO NOT use the restroom before gonorrhea and chlamydia testing. In most cases, you should not have urinated for at least one hour before the test.
  • HCV RISK ASSESSMENT AND TEST CONSENT

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