Leawood Pediatric Forms
There is no charge for forms (except FMLA forms - see below) completed at the time of your child's well visit .
Charges for forms completed outside of a well visit or FMLA paperwork:
$10 - Form will be completed in 7-10 business days from date of payment
$25 - Form will be completed within 48 hours (additional "Rush Fee" of $15) from date of payment
$40 - FMLA & other extensive paperwork (completed in 7-10 business days) from date of payment
These charges cover the staff and physician time to complete this paperwork.
Please see our financial policy for details.
If you need forms completed for your child outside of a well visit, you may drop off the form at our front desk, mail (5401 College Boulevard Suite 101 Leawood, KS 66211), e-mail (medicalrecords@leawoodpediatrics.com) or fax (913-948-9128) to our office. If you mail/e-mail/fax the form to our office, your card on file will be charged the forms fee unless you make other arrangements with our front desk staff.
Please complete the Paperwork Request Form and include with your documents to ensure timely return & accurate processing of your paperwork.
ADHD
Adolescent Well Visits
For adolescents 11 years and older, please print the age appropriate preventative health form below. Give your child the opportunity to complete this form privately prior to the appointment and place it in a sealed envelope. Please be sure to bring this completed form to the appointment. This detailed assessment allows your child to openly discuss crucial information with their pediatrician that can have significant health impacts.
Immunization Consents
Medical Records
New Patient