Patient Forms

You’ll find a variety of patient forms on this page to help you get started for your visit. If you have questions or need additional forms, just let us know and we’ll be happy to assist you..

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Patient Demographics

A link will be sent to you and is valid for 72 hours.

Child Treatment Authorization

Treatment Consent for Third Party Bringing Child – If your child will coming with someone besides their parent or legal guardian.

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HIPAA Privacy Policy

Information listed below are referenced in the patient forms and can be printed for your file.

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Medical Release Authorization

Please complete the form below to authorize release of your child’s medical information. Medical records sent to another provider for continuity of care do not have associated fees. This form must be complete, including the date and signature as we cannot process incomplete forms. Medical Record reproduction fees for personal use are listed below:

$18.97 for base fee

$0.63 per page

$20.00 for CD of radiographs

Authorization Form for Release of Medical Records

Please sign, date and fax this form to (913) 491-0547, or submit to our office by hand, by mail, or by scanning and emailing to businessoffice@pedorthokc.com

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Need Urgent Care or Have Questions?

Visit our Walk-In Clinic for immediate orthopaedic care—no appointment or referral needed. Or, contact us directly for appointments and inquiries. We're here to help!

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