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Harbor View Medical Clinic

Thomas C. Thomas M.D.
110 Westwoods Dr.
Liberty, MO 64068
(816)781-6127

Todays Allergy Counts

Administrative Forms
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Patient Information Form
- Required for all new patients and patients with new personal information. -

Please complete this form, print it and bring it to the office at the time of your appointment. (Some portions of the form must be completed after printing.)

Allergy History Form - Required for all new allergy patients. -

Please complete the form, print it and bring it in to the office at the time of your appointment.
(Recommended for High Speed connections only. If you have a Dial-up connection, use this version to print and complete.)

Read our Privacy Policy.
The HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) requires the publishing or our policy regarding the security and handling of your personal information.

Read our Financial Policy.