Notice to Clients
Funding for the Family Healthcare Clinic is provided by the city of Kansas City, Northland Healthcare Access, and the Platte County Health Department
Payment Responsibility
I agree to pay for services and/or supplies incurred at the rate indicated on the Family Healthcare Fee Schedule. Failure to comply with this agreement may jeopardize my ability to continue receiving services at the Platte County Health Department-Family Healthcare Clinic.
Cancellation of an Appointment
In order to be respectful of the medical needs of other patients, please be courteous and call the clinic promptly if you are unable to shopw up for an appointment. We ask that you call at least 24 hours in advance.
Patients who schedule and then do not keep 3 appointments, within a year, may jeopardize your ability to be seen in a timely manner. Patient will be counseleed upon 3rd No-Show with future appointment options.
I have read and understand the above agreement.