We are looking forward to your appointment. If you would like to fill out the new patient paperwork in advance please download the pdf versions of all the necessary forms below.
Registration Form
This form provides us with your contact information. It also provides you with the opportunity to tell us how you would like to be communicated with.
HIPPA Consent Form
The HIPPA Consent form is used to protect your privacy. Only those listed on your HIPPA form may be given access to your medical records.
Credit Card Authorization Form
Some of our patients prefer to use a credit or debit card to pay any remaining balances after insurance. This form is required to authorize us to charge your account.
Medical History Form
This form provides us with your contact information. It also provides you with the opportunity to tell us how you would like to be communicated with.
Insurance Form
This form is used to grant us permission to use your insurance benefits toward treatment at our offices.
Financial Policy Agreement
This form provides you with access to our Financial Policy. All patients are required to sign this form as an official acknowledgment of our Financial Policy.
Financing Your Procedure With Affordable Options
Sometimes insurance doesn’t cover every procedure our patients need. For that reason, our office has partnered with Prosper Healthcare Financing and CareCredit to provide our patients with access to quality financing options for their procedures.
Get a custom rate in 1 click at the prosper website.
Get Prequalified for CareCredit Here!
Have Questions? Call 816-792-3400 or
Pre-Qualify Today!