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
Fivserve
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
Medicare
Medicaid of Kansas
Medicaid of Missouri
Mutual Of Omaha
Principal Healthcare
Preferred Health Professionals
Private Healthcare
Reserve National Life
Tricare
United Healthcare
Union Bankers
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.
