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 from date of payment (RUSH form fee)
$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, send through your patient portal, mail (5401 College Boulevard Suite 101 Leawood, KS 66211), e-mail ([email protected]) 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. 


Mental Health

Ages and Stages Questionnaires

As recommended by the American Academy of Pediatrics, here is the appropriate questionnaire for you child's upcoming appointment.  Please fill this out one week prior to your next visit and allow 10-15 minutes to complete this screening.  This needs to be brought with you to your visit and cannot be completed in the office.  This is an important developmental screen that will assist the pediatrician in evaluating your child.

Immunization Consents

Beyfortus Consents

Medical Records

New Patient


Medical history form must be completed by student and parent/guardian prior to physician completing.

Our Location

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Hours of Operation

Our Regular Schedule


8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm