Forms

Below are multiple forms that you will need to fill out based on your various recommended services or before proceeding forward with care. If you do not see the form you are looking for, please contact us at 316-683-6766


First Visit Forms

Patient Information                                                         Privacy Notice

New Patient History
                                                        Cancer Screening

Payment Policy                                                                 Privacy Practices


Credit Card Authorization Form                                Limited Waiver for non-covered Services



Surgery Consent Forms

Anterior & Posterior repair of the vagina                Bladder Neck Suspension

Vagina Hysterectomy                                                       Laparoscopic Tubal Ligation

Abdominal Hysterectomy                                               LEEP Procedure

Dilation & Curettage


Other Information

Record Release Request

Expectant Parent Form

Release of Records