Primary Care Family Practice

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Customer Satisfaction Survey

We just made it even easier for you to fill out your online paperwork before you come visit your family physician. Just click on the link below and get started now.
https://onlineforms123.com/Welcome.aspx

New - Adult Patients
Patient Information Sheet (English)(Vietnamese)Adult Health History
HIPAA Form (English)(Vietnamese)

New - Pediatric Patients
Patient Information Sheet (English)(Vietnamese)
Pediatric Health History (English)(Vietnamese)

Welcome to Medicare Physical
Personal Medical History Patient Screening
* both need to be filled out prior to your appointment

School Forms
Kansas Sports Physical Form

Legal Forms
Durable Power of Attorney Form
Rules: Witnessing Advance Directives in Kansas & Missouri

Miscellaneous
Consent to Treat Minor
Injury Form (English)(Vietnamese)
(required by your insurance company for motor vehicle accidents, liability claims, falls, sprains, bug bites, dog bites, etc)
Insurance Change
Address or Phone Number Change
Name Change (English)(Vietnamese)
Do Not Resuscitate
New-Disability/FMLA Form (English)