Office Info

Patient Information Forms

For your convenience, we offer the option of completing your Patient Forms electronically – right from your browser.

Click Here to use our Online Electronic Forms

Otherwise, you can download and print the same forms using the links below.

Downloadable Forms

Please print and complete all forms and bring them with you when you come in for your appointment.

Patient InformationPatient HistoryPatient Medications

Financial Information

Insurance

We are contracting providers for: MedicareBlue Cross/Blue Shield of KansasAetnaPreferred Health Systems, & Vision Care Direct. We are happy to assist you in completing “out of network” forms for plans such as VSP, Superior and EyeMed.

CARECREDIT

We accecpt CareCredit which is a flexible patient payment program, specifically designed for health care expenses.

Visit the CareCredit Website for more information.