2 Easy steps to see if we can qualify you:
**no commitment whatsoever by completing these steps.
**everything is confidential
- Fill out the 1 page Informal Inquiry (basic information)
- Sign the HIPAA forms (4 signatures). This allow us to look at your medical information.
These forms are available to download and print. You can then fill them out and fax them to 913-671-1859.
You can download the Informal Inquiry here. (Word Document)
You can download the HIPAA Forms here. (PDF document)
(Please download both if you intend to fax in your forms)
If you would like to complete these forms online click below to continue to the first form.
Call Jay Gaudreau at 316-650-0001 if you have any questions. |