new patients

To make your first visit easier, please print and fill out the following forms to bring with you.

Schedule a Consultation/Appointment

Name(Required)

First Last

Email(Required)

Phone(Required)

Services Requested(Required)

Preferred Appointment Time(Required)

Mornings

Afternoons

Any additional information?

Do you have your insurance information?

Providing this information will speed up the check-in and billing processes. We can also ensure services requested are covered with your insurance.

Yes

Employer associated with insurance company

Subscriber Number

Group Number

Policy Number

Date

Patient Address

Street Address City State / Province / Region ZIP / Postal Code

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4951 NE Goodview Cir
Lee’s Summit, MO 64064

Monday & Tuesday 7:30am-5:00pm
Wednesday 8:00am-5:30pm
Thursday 7:30am-4:30pm
Fridays Available by appointment

For holiday hours, please check our facebook page for announcements.

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