Tell us about Yourself
All patient information is completely confidential. We are HIPAA compliant and protect patient privacy at all times.
What to bring to your visit?
A valid driver’s license, passport, or other valid form of identification. A list of medications you are taking, including dosages and directions. Also, any reports or diagnosis from your primary care physician.
Will I Pre-qualify?
For Immediate answers, call 816-944-3654 or send us an email at firstname.lastname@example.org
When you submit this form, your information will be reviewed by one of our physicians. We will review your information and get back to you with your pre-qualification results.