1004 Carondelet Drive, Suite 310
Kansas City, Missouri 64114

icon phone816.942.KIDS (5437)childrens health network

For a speedier first visit, please complete the forms below prior to your visit to our office and update as information changes.

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Privacy Notice Receipt
Privacy Notice Receipt
Patient Information
Patient Information
Patient History
Patient
History
 

Notice of Privacy Practices

Notice of Privacy Practices 2017

Financial Policy

Financial PolicyWe accept most major insurance plans and we will file your claims with your carrier. Since there are so many different health insurance plans, please familiarize yourself with your insurance plan and be prepared to pay all co-payments, deductibles and balances due from prior visits, at each visit. For your convenience we accept CASH, CHECK, DISCOVER, MASTERCARD, VISA, AMERICAN EXPRESS and HSA Cards.

Before making an appointment, please verify with your insurance carrier that we are “in-network” on your plan. Your insurance card should be presented at each visit.

Unfortunately, we do not accept Medicaid/Medicare.

Please be aware that if you do not show for a set appointment, or cancel without 24 hours notice, a 25.00 fee will be assessed.

Please read, sign, and date the Financial Policy form above to indicate that you understand the financial policy set forth in the document.

Modified Checklist for Autism in Toddlers - revised

Autism ChecklistThis checklist can help you determine if a professional should evaluate your child. This simple online autism screen takes only a few minutes. If the answers suggest your child is at risk for autism, please print the checklist and consult with your child’s doctor. Likewise, if you have any other concerns about your child’s development, don’t wait. Speak to your doctor now about screening your child for autism.

 


Children’s Mercy – Cradle Thru College Care
1004 Carondelet Drive, Suite 310  •  Kansas City, Missouri 64114  •  816-942-KIDS (5437)  •  Fax 816-942-4830