Forms

*If you utilize Adobe Reader to open the following PDF forms, please be sure to use the most-current version, 10.0.1, to prevent your web browser from freezing. Click here to download this version. 
 
Referred for a Consultation?
Please print and fill out the following:

• New Consultation Packet  
  • This packet includes the following forms:
    • Acknowledgement & Consent for Messages form
    • Patient Information form
    • Health History Form
 

Referred for an EMG Test only?
Please print and fill out the following:

• EMG Test Packet
  • This packet includes the following forms:
    • Acknowledgement & Consent for Messages form
    • Patient Information form 

For your convenience, we have also listed the following forms for completion if they fit your specific situation:

• Patient Information Form  
• Health History Form     
• Acknowledgement & Consent for Messages Form    
• REFERRING PHYSICIANS Faxable Scheduling Request Form  
• MRI Questionnaire 
• LP & CT Scan Questionnaire 
• Medical Record Release to Shawnee Mission Neurology Consultants   
• Medical Record Release from Shawnee Mission Neurology Consultants