7235 W 162nd Terr

Stilwell, KS 66085

info@PediatricConnectionsOT.com

Pediatric Connections

Tel: 913-257-5808

Fax: 844-270-5788

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Privacy Policy

 

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 PEDIATRIC CLIENTS:

1.  Client Information   *START HERE*

2.  Payment Policy/HIPPA

3.  Pediatric History

4.  Cancellation Policy

     

     Speech Language History

     Release of Information (optional)

 

MANDATORY FORMS FOR ADULT CLIENTS:

1.  Client Information   *START HERE*

2.  Payment Policy/HIPPA

3.  Adult History

4.  Cancellation Policy

5.  Release of Information (optional)

 

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 Shied - Blue Select

Aetna

Coventry

Cigna

Humana

Missouri Health Net

Missouri Medicaid

 

Private Pay (contact our office for fee schedule)