Form Center
Patient FormIn advance of your visit, please fill out the form below. We will have it printed and in your file when you arrive. You will need to sign it on your first visit to the office. If you have previously completed a form and this is an update, please ensure all details are included because your old forms are shredded. We also ask that you always bring your most current insurance card so it can be scanned in your child's file. Insurance information or changes require a new copy of your card, and cannot be simply amended with the completion of a new form. If you would like to fax an enlarged copy of both the front and back of your card, rather than scanning one in the office, you may do so. Our fax number is 913.384.5209. Thank you. The form will open in a new window. You will need to disable your pop-up blocker in order to view it. Click to open: Open Patient Form |
Release of Medical RecordsA parent or legal guardian may request, on a one time basis at no charge, the following information: a copy of each child's growth chart, immunization record and last well check-up. Any additional copies of the above information or any other copying requests for that patient will be billed at the rate governed by Please use this form to request the medical records for your children. After you have completed and signed the form, feel free to return it to the office or simply fax it to us at 913.384.5209. Remember that it generally takes one to two weeks to complete your request. Thank you. Click to open: Release of Medical Records |