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Patient Forms

Midwest Medical Specialists has invested in your healthcare by moving to an electronic check-in system called Phreesia.  This system eliminates the need for you to complete the customary paperwork required at the time of your appointment.  You will be receiving an email with instructions on how to complete your online registration 3 days prior to your scheduled appointment.  

If our office does not have your email address please call our office at 816-454-2655 and provide us with your email address.  

Once your email is on file with our office, we will email you prior to your appointment and this will allow you to complete your pre-registration at any time prior to your appointment.  If for any reason you do not complete your pre-registration prior to your appointment, please arrive 30 minutes prior to your appointment and you will be given the opportunity to complete your registration information on a computer pad in our waiting room.  However, our patients find that by completing their registration prior to their appointment, the check in process is seamless.  

We would like to thank you for helping us serve you better!

The forms below are provided for your information only.  They are not required at an appointment.  You may click on any form icon below to open an Adobe Reader file of that form to read and review the information as needed.


Medication List
Medication List
FMLA Request
FMLA Request
Records Release
Records Release
Financial Policy
Financial Policy
(read only)
Notice of Privacy Practices
Notice of
Privacy Practices
(read only)

5330 North Oak Trfwy.
Suite 201
Kansas City MO 64118
P 816-454-0666
F 816-454-1694

Liberty-Seaport Complex
124 Westwoods Drive
Liberty MO 64068
P 816-883-2965
F 816-454-1694

8901 W. 74th Street
Suite 145
Merriam KS 66204
P 913-722-0020
F 913-362-0583

College Boulevard
8490 College Boulevard
Overland Park KS 66210
P 913-722-5551
F 913-362-0583


Skin Renewal Scheduling
(Creekwood and College)