Form Center

2. Please complete the form below and a staff member will respond to your question or request as quickly as possible. Please allow more time for a response on evenings and weekends.

   If you have a question, you may be able to more quickly find an answer by visiting the webpage for the program you are trying to reach. Use the tabs at clayhealth.com to find those pages. 

   Thank you!

4. First Name
5. Last Name
7. Your Email Address*
8. Your Phone Number
10. Who would you like to contact?*

    1. Environmental Health (Food, Pool, Septic, Lodging, Vector)
    2. Immunizations
    3. Epidemiology
    4. Health Equity & Community Development
    5. Immunization Records
    6. Vital Records (Birth/Death Certificates, Medical Records)
    7. Sexually Transmitted Infections
    8. WIC (Women, Infants, Children)
    9. Dental
    10. Communications (Events, social media, media, website, etc.)
    11. Emergency Planning
    12. Other/General
12. What city is the service or request for?*

    Any complaints or needs related to food establishments, pools, septic, vector or lodging in Kansas City should be directed to the KCMO Health Department instead.

14. Please describe your request/question in detail.*
16. I understand this form is not secure. Any Protected Health Information that I may share in my submission is at my own risk and Clay County Public Health Center cannot guarantee its security.*

    1. I understand
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field