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Two forms to fill in and one to read, on your phone or on paper. About twenty minutes in all.
Fill out the forms here and they’ll go straight to your file at the practice. Nothing is kept on this website. Start with the registration; the consent form follows it, and the privacy notice is there to read before you sign.
Or print the PDFs, complete them, and bring them to your first appointment, or fax them to 816.886.6242.
No printer? Come a few minutes early and Naomi will have paper copies ready at 605 NE Woods Chapel Road.
Who you are and how to reach you, who else lives at home, and a short history: what you are seeking help for, any medications, and anyone you have seen before. If the client is under 18, it asks about the parents or guardians instead of a spouse.
How the practice uses and protects your health information, and the rights you have over it. There is nothing to fill in. Read it and keep it; your signature on the consent form confirms you received it.
The informed consent for counseling, the professional disclosure statement, and an authorization naming anyone else who may have access to your information. The client signs at 14 or older; for anyone under 18 a parent or guardian signs as well.
Leave it blank and ask. Naomi picks up on weekdays, and nothing on these pages has to be perfect before you walk in.
