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Northeast Missouri Health Council

Patient Forms

New Patient at any Family Health Site 0-17 yrs

Slide Income Guidelines

New Patient at any Family Health Site 18+ yrs

Sliding Fee Application

New Patient at any Dental Site 0-17 yrs

Proof of Unemployment Form for Slide

New Patient at any Dental Site 18+ yrs

Medical and Dental Record Release Form (FROM NMHC)

Mobile Dental Unit Packet

Medical and Dental Record Release Form (TO NMHC)

New Patient at NE Pediatrics 0-4 yrs

Behavioral Health Record Release Form

New Patient at NE Pediatrics 5-18 yrs

Patient Satisfaction Survey

New OB Patient at OBGYN Specialty Group

NMHC HIPAA Notice of Privacy Practices

New GYN Patient at OBGYN Specialty Group

NMHC HIPAA Notice SPANISH

HIPPA Form 2022

NMHC HIPAA Notice FRENCH

Cystic Fibrosis Consent

VA 1010EZRenewal

Northeast Family Health

1506 Crown Drive

Kirksville, MO 63501

Phone: (660) 627-4493

After Hours: 1-844-820-9111

Hours: M, T, TH: 7:30 a.m. - 12:00 p.m.

1:00 p.m. - 6 p.m.

Wed: 7:30 a.m. - 12:00 p.m

1:00 p.m. - 5 p.m.

Fri: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Northeast Pediatrics

402 W. Jefferson Suite A

Kirksville, MO 63501

Phone: (660) 627-2229

After Hours: 1-833-745-2217

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

OB/GYN Specialty Group

402 W. Jefferson Suite B

Kirksville, MO 63501

Phone: (660) 665-3555

After Hours: 1-844-820-9111

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Edina Family Health

104 E. Jackson

Edina, MO 63537

Phone: (660) 397-3517

After Hours: 1-844-820-9111

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Northeast Dental

402 W. Jefferson Suite C

Kirksville, MO 63501

Phone: (660) 665-2741

After Hours: 1-844-820-9111

Hours: 7:45 a.m.-11:45 p.m. & 12:45 p.m.-4:45

Macon Family Health & Macon Dental

209 N. Missouri

Macon, MO 63552

Phone: (660) 395-5045

After Hours: 1-844-820-9111

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Kahoka Dental

22291 US Highway 136

Kahoka, MO 63445

Phone: (660) 727-1500

After Hours: 1-844-820-9111

Hours: M, T, W, F 7:00 a.m. - 12:00 p.m.

1:00 p.m. - 4:00 p.m.

Thursday: 7:00 a.m. - 12:00 p.m.

Northeast Family Health - Milan

52334 S. Business Highway 5

Milan, MO 63556

Phone: (660) 265-1042

After Hours: 1-844-820-9111

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Northeast Behavioral Health

1410 Crown Drive

Kirksville, MO 63501

Phone: (660) 627-3621

After Hours: 1-844-820-9111

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Diabetes & Nutrition Center

1506 Crown Drive

Kirksville, MO 63501

Phone: (660) 627-4493, Ext. 412

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Kirksville Veterans Clinic

506 Rosewood Drive

Kirksville, MO 63501

Phone: (660) 627-8387

After Hours: 1-844-820-9111

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Business Office

1416 Crown Drive

Kirksville, MO 63501

Phone: (660) 627-5757, Ext. 6

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

Administrative Offices

1416 Crown Drive

Kirksville, MO 63501

Phone: (660) 627-5757

Hours: 8 a.m.-12 p.m. & 1 p.m.-5 p.m.

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This health center is a Health Center Program grantee under 42 U.S.C 254b, and deemed Public Health Service employee under 42 U.S. C. 233(g)-(n)

Northeast Missouri Health Council is a FTCA deemed facility. Malpractice coverage is provided under the Federal Tort Claims Act (FTCA) pursuant to 42 U.S.C. 233(g)-(n).

HIPAA Privacy Notice

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