| Join
the Couch-to-5K team! We are currently training for the St Patrick's 5K fun run on March 17, 2012 in Wichita ($20-$25 race fee). Training times: Saturdays at 9:00am Tuesdays at 5:30pm at Andover Family Medicine. Dress warm for outside training! Call or email Jana to join! |
Word forms can be filled out on your computer by using the tab button on your keyboard to advance to the next area.
New Patient Forms - PDF or Word File
Patient Information Forms - PDF or Word File
Past Medical History Questionaire - PDF or Word FileConsent to Treat a Minor - PDF or Word File
Allows someone other than the legal guardian to consent to treatment of the minor.Permission to Disclose Information - PDF or Word File
Allows permission to disclose information for care & notification purposes to other individuals i.e. spouse, friend, children, significant other.Medical Records Release - PDF or Word File
Allows the patient to release medical records to another physician or obtain records from a previous physician.Well Women Exam - PDF or Word File
This form can be completed prior to your scheduled annual examWell Male Exam - PDF or Word File
This form can be completed prior to your scheduled annual exam.Preventive Care Questionnaire - Medicare - PDF or Word File
This form can be completed prior to your scheduled exam.
