Patient Portal & Forms

Telemedicine Consent Form  If you are scheduled for a Telemedicine visit with our office, please complete this form. 

Records Request If you would like a copy of your records sent to another physician, please print and complete this form. Please note, there may be a fee associated with sending medical records to another provider. The following fees could be charged, in accordance with the Kansas Department of Labor:

• Up to 10 pages: $16.00
• Up to 50 pages: $28.00
• Over 50 pages: $28.00 + $0.35 for each page over 50