Online Check In
Complete your paperwork online and submit it before your visit! After completing the form select the "Submit" button at the bottom of the form and your completed paperwork will be waiting for you and your signature upon your arrival. You can also complete the paperwork, print a copy and bring it with you (please type as much information as you can before printing or submitting.
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Patient Information Form - complete each visit.
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MRI Assessment From - complete if you are having a MRI.
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Bone Density Survey Form - complete if you are having a bone density screening.
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Patient Self Pay Form - complete if you are paying for your visit out of pocket.
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Work Comp Verification Form - complete if you are submitting a Work Comp Claim.
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Don't forget your insurance card and co-pay.
Physician's Forms
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Physician's Encounter or Referral Form - Password required to open this form. Please contact our office for Physician password.
Insurance Providers Accepted
- Aetna (PPO, Open Access)
- BCBS of Kansas (PPO, Blue Advantage, Premier Blue & Blue Select)
- BCBS of Kansas City (MRI and Echo)
- Cigna (HMO, PPO)
- Champus
- Coventry (PPO)
- Federated Mutual
- First Health
- Fortis
- Freedom Network (MRI & Echo)
- Gallagher Bassett
- Guardian
- GEHA
- Golden Rule
- Great West
- Hartford
- Healthcare Preferred
- Health Midwest Comp Care
- Humana PPO
- Humana HMO
- John Alden
- John Hancock
- Key Health (MVA)
- MDM/Diatri (Work Comp)
- Medicare
- Medicaid of Kansas
- Medicaid of Missouri
- Mutual of Omaha
- Principal Healthcare
- Preferred Health Professionals
- Private Healthcare
- Reserve National Life
- Tech Health
- Tricare
- UMR (formerly Fivserve)
- United Healthcare
- Union Bankers
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- Wausau
Employment Application
If you have problems with the forms please download the latest version of Adobe Reader for FREE. You can also complete the form and print it and then bring the printed copy to the office with you.
