Our Mission

At our office, we believe that raising a child is a rewarding - as well as a challenging experience for a parent. Our goal is to help you enjoy this experience and to ensure that your child's full potential is reached. We believe that healthy children are a direct result of healthy families and communities.

Policies

Dear New Patient:

On behalf of the entire staff, I'd like to welcome you. Our staff is our most important resource to deliver services to our patients and community. The ultimate purpose of all work in this office can be stated in two words:

"HELPING PEOPLE"

Our patients ask for our help and our goal is to deliver the best quality medical care within our capabilities and to serve our patients promptly, courteously and efficiently.

Many of the rules and policies of this practice are intended to build the confidence a patient feels in the doctors and the other personnel who work in this office. A strong doctor/patient relationship is essential if the patient is to receive full benefits from the doctor's services. Patients must feel sure that they can talk freely to the doctors, that the doctor is knowledgeable and conscientious, and that the office is well managed. Only if these attitudes prevail will the patient be likely to take the doctor's advice, and do his or her part in following through with the treatment plan. We play an important part in building this confidence by being cheerful, friendly, tactful, neat and industrious.

Please know that we're always open to suggestions that might improve our office or patient care and we sincerely hope that your care with us will be rewarding.

WELCOME TO OUR PRACTICE!

Sincerely,

Kelly Bolin
Office Manager

Patient Forms

We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.

• New Patient Registration Packet
• No Show and Appointment Cancellation Policy Form
• Medical History Form
• Consent for Medical Care
• Allergy Questionnaire
• Financial Policy
• ADHD Parent Form
• ADHD Preschool Form
• ADHD Teacher Form
• ADHD Symptom Score Sheet
• Anxiety Evaluation Parent Form
• Anxiety Evaluation Child Form
• Anxiety Evaluation Screen - Adult Form
• Asthma Assessment for Ages 4-11
• Asthma Assessment for Ages 12 and Older
• GAD-7
• PHQ-9

• MCHAT
• MO Day Care Form
• MO Sports Physical Form
• KS Day Care Form
• KS Asthma Action Plan
• KS Certificate of Immunizations
• KS High School Physical Form
• Breastfeeding Checklist
• Medical Record Release of Information
• Medical History for Allergy Form
• Flu Consent Form
• Covid Vaccine Consent Form

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

What to Expect

The Initial Visit

Our compassionate Prairie Village pediatricians and Nurse Practitioners do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and your child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.

If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:

• Insurance cards
• Complete immunization records
• Medical records from your previous pediatrician

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