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Patient Forms

New Patient Intake

For all new and interested patients. Must be filled out prior to scheduling first appointment. 

Controlled Substance Policy

Please review our controlled substance policy. 

Referrals

If you are a hospital, provider, or other home health company referring a patient, please submit the information through this link. 

Notice of Privacy Practices

For all new and interested patients. Must be filled out prior to scheduling first appointment. 

Medical Release

For all new and interested patients. Must be filled out prior to scheduling first appointment. 

Insurance Release

For all new and interested patients. Must be filled out prior to scheduling first appointment. 

Primary Care at Home

Here at House Calls KC we strive to keep patients in their home and out of the hospital longer. We see patients who are homebound or have a difficult time leaving the home for in-office appointments. If you or someone you know struggles to leave the home for health care, clink the link above to get set up with a new patient appointment. We look forward to hearing from you!

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