Patient Paperwork and Consent to Treat

Please use this form to complete new patient paperwork and consents for mobile units and school-based care. For questions, please call or email our Mobile Unit team.

  1. Call (417) 831-0150
  2. Email us

Upcoming Events

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Free Flu Shot
Health Clinics

Free Patient Flu Shots

Stop by any Jordan Valley Health medical clinic to get this year's flu vaccine for *free. Walk in or schedule an appointment. No cost to you with most insurance.

All day

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Dentist Cleaning Childs Teeth
Mobile Clinic

Sweeny Elementary Dental Clinic

We will stop by Sweeny Elementary School to provide dental care for students. Haven't filled out your child's consent forms yet but want them to be seen? Start here.

All day 720 N Main, Republic, MO 65738

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Child Exiting Mobile Unit
Mobile Clinic

Good Samaritan Boys Ranch Vision Clinic

We will stop by the Good Samaritan Boys Ranch to provide vision care services to participants.

All day 5549 Hwy K, Brighton, MO 65617

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