Patient Forms

For your convenience, we have made a number of forms available for patients to download. If you are new to our practice, we encourage you to download and print out the new patient forms. If you’re not sure which forms you need, please call (913) 871-1166 for assistance.

1. 1. Please print and complete the New Patient Forms.  Please bring these with you to your appointment.
2. 2. Review our Notice of Privacy Practices online, or print them.  Print and Sign the Acknowledgement of Receipt of Notice of Privacy Practices.
3. 3. Review our Payment and Insurance policy information.

If you’re unable to open these files, you probably need to download the free Adobe Acrobat Reader program, which is available at the following location: www.adobe.com/products/acrobat/readstep.html

Click on the forms you would like to download:

• New Patient forms
• PRK Post-Op Instructions
• SBK-LASIK Post-Op Instructions
• CK Post-Op Instructions with Tetracaine
• RLE and Cataract Post-Op Instructions
• Verisyse Phakic IOL Post-Op Instructions
• Visian Phakic IOL Post-Op Instructions
• Notice of Privacy Practices
• Acknowledgment of Privacy Practices
• How to Choose a LASIK Surgeon

For Professional Use Only

• Comanaging Doctor Form
• Comanaging Doctor Post-Op Form