We ask that whenever possible, patient forms be hand-carried to the office since we can not guarantee the receipt of documents sent by mail.

New patients: please click the link above for new patient forms and other helpful information.

Established Patients

If you have been asked to complete a health history form, please complete and bring in this document.


Health History

For name or address changes: please complete this form and bring to your next appointment.


Patient Demographics

To view our privacy policy, please read this document.


Privacy Practices

To grant permission for certain individuals to have access to records and discuss your care please complete and return this form.


Receipt of Privacy Practices

If you need to request medical records or have records transferred, please complete and return this form.


Medical Records Release
To view our financial policy, please read this document.
Financial Policy
Click on the icon for any form to download an Adobe Reader® file of that form. If you don’t have Adobe Reader on your computer, please click here for a free download.



Johnson County OB/GYN Chartered  •  7440 W. Frontage Road  •  Merriam, Kansas 66203  •  913-236-6455