Forms

The forms below can be printed and completed from home. Forms 1,4&5 must be competed by everyone. Forms 2&3 will be filled out based on patient.  Having these forms filled out prior to visit may speed up your waiting period.

Form 1

Patient Registration Form

Form 2

Patient Consent Form - Minor

Form 3

Patient Consent Form - Adult

Form 4

Hippa Privacy Form

Form 5

Payment Authorization Form

Contact Us

Physician Now - Urgent Care

22334 W 66th St.

Shawnee, KS 66226

​Tel: (913) 825-0909

Fax: (913) 825-0905

Monday - Friday: 9:00am – 8:00pm    Saturday - Sunday: 9:00am – 5:00pm

Copyright © Physician Now - Urgent Care. All rights reserved.