Patient Forms

New Patient Forms

The forms below may be printed and completed before coming to our office.

Patient Registration Form
The Patient Registration Form is for new patients or those who need to update their address or insurance information. Please give the completed form to the receptionist when you arrive.

Patient Consent for Use and Disclosure of PHI
The Patient Consent for Use and Disclosure of PHI reviews PRFM policies regarding how we safeguard your medical records. Please give the completed form to the receptionist when you arrive.

Authorization to Release Medical Information
The Authorization to Release Medical Information allows you to decide which family members or friends PRFM may communicate with about your health. Please give the completed form to the receptionist when you arrive.

Other Patient Forms

KSHSAA Sports Physical Form
The KSHSAA Pre-Participation Form is required for sports participation in Kansas schools. It must be completed after May 1 for the following school year.

KSHSAA Concussion Policy (2011)
This policy was established and published by KSHSAA in 2011 about concussions and student athletes.  New changes in return-to-play rules include no return to play on the same day as injury and recommending graduated participation upon return.

KSHSAA Concussion Consent Form (2011)
This consent form is required for sports participation beginning this year.  It outlines the new policy and expectations for athletes.