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Thanks for giving John such good care. We appreciate your service and will ask if you will do it again in a year.

Jeanne H., Special Needs Patient

Questions? Contact us:

Phone

316.788.5939

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Patient Forms

Our goal is to make things as easy as possible for our doctors and patients. Please click on the link below to complete our Sedation Request Form.

After the Sedation Request Form is submitted, within 24 hours you will receive a text message with a link to complete our sedation paperwork packet. This paperwork packet is the first step in starting the clearance process with our office for your upcoming appointment. After the paperwork packet has been submitted, a team member from our office will reach out regarding Medical Clearance if necessary, Finances/Deposit if necessary, and NPO/Pre-Op instructions.

Please call our office at 316-788-5939 if you have any questions. Thank you!

Sedation Request Form

MAILING ADDRESS: 727 N Baltimore, Derby, KS 67037