If you’re a new patient, please complete the following forms. You may print them and then complete; you may fax to (785) 851-4343 or email to email@example.com.
For your convenience, you may open them in Adobe Acrobat and complete the information on your computer.
Information and Agreement Form:
Please click the form which applies to you
- INFORMATION & AGREEMENT FOR MINORS
- INFORMATION & AGREEMENT WITH INSURANCE
- INFORMATION & AGREEMENT WITHOUT INSURANCE
For Your Information and Review: NOTICE OF PRIVACY PRACTICES