

Call us if you need help or information:
Missouri: 816-941-2550
Kansas: 913-888-0014
PLEASE NOTE: You MUST save the file to your computer prior to filling out so all information saves properly, and you are able to provide and e-signature.
Click here to download the Request For Patient Info Release Authorization form
Click here to download the Health Information Privacy Notice
Click here to download the Notice of Nondiscrimination