NEW PATIENT FORMS

After contacting our office to schedule an appointment, if you're a new patient you can save time during your initial visit by filling out the forms online or downloading and filling out the following forms.

 

If you choose to use the online forms, simply fill them out online and submit them. We will have your submission ready when you arrive for your appointment.  If you prefer, you may download, print and fill out the downloadable versions. Please bring the completed forms with you to your appointment.

 

Downloadable Forms

 

Patient Information

Health History

Practice Policies

Credit Card Authorization

Privacy Practices

Records Release

 

 

 

© 2013 VALERIE DRAKE-ALBERT | PRIVACY POLICY

TALLGRASS EXECUTIVE PARK | 8100 E 22ND, BUILDING 2200-2, WICHITA, KS 67226 | 316.440.8383

WEBSITE DESIGN BY