The Midwest's premier orthopedic group

North Kansas City Office 2790 North Clay Edwards Drive, Suite 600 • North Kansas City, MO 64116 • (816) 561-3003
Centerpoint Medical Center 19550 E. 39th Street, Suite 410 • Independence, MO 64057 • (816) 303-2400

PATIENT FORMS

For your convenience, we have enclosed our patient information and medical history forms which should be completed prior to your appointment. To expedite your check-in, you may email the completed forms back to our office, or you may bring them with you at the time of your office visit, please bring your current insurance card(s) to each visit. If your insurance plan requires a co-payment and/or a referral form from your primary care physician, this should be presented when you arrive for your visit.

Click to dowload:
Medical History (Word Document)
Medical History (PDF)

Registration(PDF)

It is very important for our doctors to have the results of all recent tests and diagnostic studies pertaining to your problem at the time of your visit. Please contact your primary care physician/referring doctor to obtain copies of these records to bring to your appointment. If you have had any x-rays or MRIs, please bring in the actual films as well as the report(s). These may be obtained from the radiology department in which the x-ray or MRI was performed. PLEASE DO NOT MAIL XRAYS OR MRIs.

If you arrive without the requested medical history documents and/or films, you may be asked to reschedule your appointment at a future date. Please also bring a list of all current medications and dosage you are taking.

North Kansas City Office: 816-561-3003
Independence Office: 816-303-2400

Thank you for choosing our physicians.