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HPC_2015_ClinicPhotos-197.jpg

Patient Resources


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Patient Resources


At Health Partnership Clinic, we provide quality, integrated health care to children and adults. From medical to behavioral health to dental, we are your one stop resource.

Our mission is to provide affordable, quality health care to all. And, we do everything we can to ensure you get the care you need when you need it—even for those who are unable to pay.

To fast-track the check-in process, please complete the below forms in ink and return your paperwork on or before your first appointment. If you have any questions, please call 913-648-2266.

 

NEW PATIENT REGISTRATION

AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

FINANCIAL ASSISTANCE APPLICATION

NOTICE OF PRIVACY PRACTICES

Dental outreach Enrollment Form

Dental outreach Online Enrollment Form

 

OPRIMA UNO DE LOS ENLACES QUE SIGUEN PARA DESCARGAR O VER LA FORMA.

 

INGRESCO DEL PACIENTE

AUTORIZACION PARA LA DI VULGACION DE EXPEDIENTES (HIPAA)

SOLICITUD DE ASISTENCIA FINANCERIA

AVISO DE PRIVACIDAD

Programa Comunitario de Salud dental

Programa Comunitario de Salud dental en linea por la internet

Online Bill Pay