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Appointment Request Form

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If this is an emergency, do not contact us via email, please use our emergency contact information.

Complete the following form:

Location
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Doctor
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Reason for Appointment Appointment requests are sent to your practitioner using regular email so please do not enter confidential information.
Preferred Dates & Times
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Check our office hours

Patient Type I am a / patient
First Name
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Last Name
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Telephone
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Email
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Best Time to be Reached for Confirmation
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Locations & Hours

  • Fountains Shopping Center
    6575 W. 119th St.
    Overland Park KS 66209
    Phone: 913-696-0092 or 913-991-2989
    Fax: 913-696-0095
    Emergency Contact:

    913-696-0092  State you have an emergency when you call!  If before or after hours please go to the nearest emergency room.

  • Zona Rosa Shopping Center
    8605 NW Prairie View Rd.
    Kansas City MO 64153
    Phone: 816-741-7220 or 816-868-9844
    Fax: 816-741-7228
    Emergency Contact:

    816-741-7220  State you have an emergency when you call.  If before or after hours please go to the nearest emergency room.