You may print these forms and bring them to your appointment, mail them to our office, or fax them to (785) 331-2001.
New Patient Forms: Please complete before your first appointment.
HIPAA E-Mail Authorization: This form gives us permission to email billing statements or other personal information.
Insurance Form: Please complete if you change insurance. We will also need a copy of your new insurance card.
Release of Information Treator: This form gives permission for Dr. Frank to communicate with a medical service provider. You may fill out more than one of these.
Release of Information Other: This form gives permission for Dr. Frank to communicate with a person or organization other than a medical service provider. You may fill out more than one of these.
Credit Card Payment Form: This form can be faxed or mailed if you need to make a credit card payment.