Patient Forms

Patient Forms

New patients are required to fill out the New Intake Form, Card on File Policy and Consent to Treat before the first visit. These can be emailed to frontoffice@ppadocs.com or brought to your appointment.

If you need Medical Records, you will be required to fill out and sign the Release of Medical Information. This is required for all records, charges may apply.

• New Intake Form
  
• PPA Card on File Policy
  
• Consent to Treat Without Parent
• Release of Medical Information

Physical Forms

Health forms that need to be completed outside of your child's well visit will incur a fee, depending on the processing time. Please note that we do not accept blank forms. Any questions required to be answered by the parent must be completed before the form is sent to the physician. 



• No-Rush health forms are $10 each and will be processed within 4-7 business days. 
• Rush health forms are $20 each and will be processed within 2-3 business days.
• For complex forms, such as FMLA paperwork, a $25 fee will apply, and forms will be processed within 14 business days.
  

Health forms will only be completed for patients with accounts in good standing. If your account is delinquent, it must be resolved before we can process your forms. Please call the business office if you have any questions.

• 2024Kansas State High Schools Activities Association(KSHSAA) Athletic Form
• 2023 Missouri State High Schools Activities Association (MSHSAA) Athletic Form
• Kansas Daycare Health Form
• Missouri Daycare Health Form
• Kansas Certificate of Immunization
• Boy Scout Camp Form