New Patient Forms

Please use our Patient Portal to complete New Patient forms and Health History forms online.

Medical Records Forms:

If you wish to fax medical record requests, please print the form, complete and fax to
913-338-1311.

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.


Other Forms

Allergy

Colonoscopy Prep Options

Dermatology

Family Practice

Functional Medicine Clinic

General Use

Imaging

Neurolog

Obstetrics (e.g. Maternity)

Orthopedic

Pain Management

Procedures

Upper Endoscopy Procedure

Vaccine Information Statements

Note: If your child received Pediarix, they received DTaP, Polio and Hepatitis B in one injection.