Patient Forms

Below are various forms available for downloading.

New Patient Forms:

NOTE: Please use our Patient Portal site to complete these New Patient forms online.

Medical Records Forms:

If you wish to fax medical record requests, please print the form, complete and fax to
913-338-1311.

Request to Amend Health Information
Medical Records Release Form 2 [from CPFCC to outside provider]
Medical Records Review/Receive Request Form [from CPFCC to patient]

Allergy Forms/Handouts:

Dermatology Forms:

Health History Form

Imaging Forms:

Orthopaedic Forms/Handouts:

Pain Management Department Health History Forms:

Procedure Forms

Pre-Anesthesia Patient Evaluation

Vaccine Information Statements

Note: If your child received Pediarix, they received DTaP, Polio and Hepatitis B in one injection.