Village Pediatrics, LLC

7301 Mission Road            Suite 350

Prairie Village, Kansas  66208

Phone (913) 642-2100            Fax (913) 642-2127

Quick Launch
  Home
About Our Practice
Paperwork/Forms
Kids Stuff

Photo Gallery

Parents Information

Human Resources

Directions

Insurance Plans

Business Office

Update My Information

 

 

Please print this paperwork, complete it and bring it with you to your visit.

 

Paperwork is available in two formats: Acrobat Reader and Microsoft Word. 

If you do not have Acrobat Reader it is a free download by pressing the icon below.

 

 

Acrobat Reader Format Documents

New Patient Paperwork Acrobat Reader Format

Established Patient Paperwork Acrobat Reader Format

Medical Records Release Acrobat Reader Format

Patient Registration Form Only Acrobat Reader Format

HIPAA Paperwork Only Acrobat Reader Format

ADHD Parent Initial Assessment

ADHD Teacher Initial Assessment

ADHD Parent Assessment Follow-Up

ADHD Teacher Assessment Follow-up

 

Microsoft Word Documents

New Patient Paperwork Microsoft Word Format

Established Patient Paperwork Microsoft Word Format

Medical Records Release Microsoft Word Format

HIPAA Consent Microsoft Word Format

Receipt of Notice of Privacy Practices Microsoft Word Format