Quality Dermatological Care Provided Directly by Physicians

Corporate Medical Plaza II
10777 Nall Ave., Suite 220, Overland Park, KS 66211
Pn: 913-469-0110
Fax: 913-469-6579
Paperwork

On-line registration is available as of May 9th, 2011 and is the preferred method of registration.

If for any reason you cannot register and fill out the on-line forms the links below will allow you to print forms to be filled out and brought in at the time of your visit. Bringing the completed paperwork to your visit and presenting it at the time of Check-In is required if you have not filled out forms on-line.
Using the links below one can view and print the forms needed for your visit- these are in transition in that they will most likely soon change and eventually be eliminated. You will need Adobe Acrobat Reader installed in your browser to view and print these files.

On-line registration is available as of May 9th, 2011 and is the preferred method of registration.

All new patients and all returning patients to the practice after 5/9/2011 should set up their Patient Portal and enter their current information there.

Paper Forms: Please review instructions for filling out the History Form under the Patient Portal instructions link available under the Patient Portal tab or from the link on our home page.

Registration Form Updated Personal History Form

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