New Patient Forms

Please print and fill out the forms below and either fax them to 913-491-1844 or bring them with you to your appointment.

Thank you,
Dr. Addy

Note: You will need Adobe Acrobat Reader to open these forms. You may download the free reader at http://get.adobe.com/reader/otherversions/

Billing & Insurance Policy

HIPPA and Consent Form

The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy.Implementation of HIPAA requirements officially began on April 14, 2003.

Medicare Opt-out

Dr. Addy had opted out of the Medicare program.  Please complete this form even if you are not currently enrolled with Medicare.

Sleep Screening Questionnaire

Your Current Physician List