New Patient Forms
Please use our Patient Portal to complete New Patient forms and Health History forms online.
- HIPAA Consent Acknowledgement
- Medicare Annual Visit Packet
Medical Records Forms:
If you wish to fax medical record requests, please print the form, complete and fax to
- Medical Records Release [from CPFCC to outside provider or self]
- Specialty Office Form Fee Guidelines
Billing payment records or ledgers without record copies: call the College Park Billing office at (913) 469-0503. Or fax written request to (913) 469-5267. There is no need to complete a Release of Information Form for billing reports.
Functional Medicine Clinic
- X-ray(s) Release Form | complete and fax to (913) 825-2765, or call 956-4200.