Pre-Registration Forms

For patients seeking orthopedic care at Kansas City Orthopaedic Institute, we make every effort to simplify the registration process. To save time during your first appointment, you can print and complete the following forms and bring them with you to your appointment. If you cannot complete the forms in advance, please arrive early to allow time to complete them here.

• Consent for Healthcare Services
• Rehab Consent for Healthcare Services
• Contracted Services
• Financial Policy
• Notice of Privacy Practices
• HIPAA Privacy Authorization Form
• Medicare Right of Appeals Form – Inpatient
• Statement of Patient Rights and Responsibilities
• Physical Therapy – Medical Screening Form
• Rehabilitation “No Show” Policy Acknowledgement Form

For more information or assistance filling out patient forms, please call 913-319-7633.

Financial Assistance Policy & Application

We provide financial assistance for patients who meet eligibility criteria. To find out if you qualify for financial assistance, please review the information provided in the documents below. To apply, please print and complete the Statement of Financial Position form:

• Financial Assistance Summary (Summary)
• Charity Care and Financial Assistance Policy (Full Text)
• AGB Calculation Summary (Summary)
• Statement of Financial Position (Form)

Located near I-435 and State Line Road, Kansas City Orthopaedic Institute combines convenience with orthopedic excellence for patients in Leawood, Overland Park, Lenexa, Lee’s Summit and other surrounding areas in the Kansas City metro. Contact us for more information.