Forms

All forms used by our office are available for download in PDF format. Open the forms in Adobe Reader and click the highlighted fields to fill out. You can then print the form and bring with you to the office, fax (913-529-5995) or save and email to our staff.

Adobe Reader software is the global standard for electronic document sharing and is free for both Windows & Apple computers. If you do not have Adobe Reader please click here to download.

 

 

New Patient Forms

 

New Patient Information

Please complete this form before your first appointment.

Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our office (913-529-5999) and we will gladly email or fax them to you.

Consent for Use and Disclosure of Health Information

Please complete this form before your first appointment.

By signing this form, you will consent to our use and disclosure of your protected health information to carry outtreatment, payment activities, and healthcare operations.

Financial Agreement

Please complete this form before your first appointment.

This form acts as authorization for the release of information necessary to process your insurance claim.

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.

 

Information Forms Re: Surgery

 

Pre-Operative Instructions

Instructions for patients being sedated.

Discharge and Post-Operative Instructions

Your overall result will be directly influenced by how well you follow all these instructions.

 

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