Forms
FOR YOUR CONVENIENCE PLEASE DOWNLOAD AND PRINT APPROPRIATE FORMS BELOW:
Registration Forms
Family Registration (one per family) - Word doc 
or PDF 
Patient Registration (one per child) - Word doc or PDF
Insurance Registration - Word doc or PDF
Emergency care - Word doc or PDF
Patient Forms
Notice of Privacy - Word doc or PDF
Financial Policy - Word doc or PDF
Transfer of records - Word doc or PDF
High School Sports Participation Forms
Kansas - PDF
Missouri - PDF
Day Care/Parents Day Out Forms
Kansas - PDF
Missouri - PDF
Scouting Forms
Class 3 Boy Scout Form - PDF
Girl Scout Health Form - PDF
ADHD assessments
Vanderbilt Initial Assessment for Parents - PDF
Vanderbilt Follow-Up for Parents - PDF
Vanderbilt Initial Assessment for Teachers - PDF
Vanderbilt Follow-Up for Teachers - PDF
Please bring completed forms with you to your appointment. You can fax completed forms in advance to:
(816) 561-8154 (Plaza Office)
(816) 554-3607 (Lee’s Summit Office)