Forms

Preparing for your first visit

Please complete all forms and submit online.
Once all forms and doctor's orders are received, we will contact you about appointment options.

Mandatory forms for all clients:

Additional mandatory forms for pediatric clients:

Pediatric History

Optional forms:

Methods of Payment

In Network Insurance Plans

Blue Cross Blue Shield
Tricare
Kansas Medicaid

Aetna Better Health of Kansas
UHC Kancare
Sunflower (with some stipulations due to high rate of denials)

Out of Network Insurance Plans

United Health Care
Blue Cross Blue Shield - Blue Select
Aetna
Coventry
Cigna
Humana
Missouri Health Net
Missouri Medicaid

*Private pay (contact our office for fee schedule)