• PATIENT INFO
    • NEW PATIENT INFORMATION
    • JOINT SEMINAR
    • ACCOMMODATIONS
    • FINANCIAL PLANNING
    • PRICE TRANSPARENCY
    • SELF PAY OPTION
    • PAY ONLINE
    • PATIENT PORTAL ACCESS
    • HEARTLAND GRILL
  • ABOUT US
    • OUR PHYSICIANS
    • AWARDS & CERTIFICATIONS
    • TESTIMONIALS
    • KSRC IN THE COMMUNITY
    • EMPLOYMENT
    • Employee Resources
  • SERVICES
    • TOTAL JOINT SURGERY
    • TOTAL KNEE SURGERY
    • TOTAL HIP SURGERY
    • TOTAL SHOULDER SURGERY
    • BREAST CARE SURGERY
  • CONTACT
Button with link to Patient Forms Page

PATIENT FORMS

Patient Forms


Patient Forms


Patient Forms


Patient Health History Form
Download Form
Inpatient Registration Forms Package

Download Form
Notice of Privacy Practices
Go to Page
Outpatient Registration Forms Package

Download Form
Release Of Information Authorization Request (PDF Format)
Download PDF
Release Of Information Authorization Request (PDF Format)

Download PDF
Release Of Information Authorization Request (Word Format)
Download Doc
Release Of Information Authorization Request (Word Format)

Download Doc
Kansas Surgery And Recovery Center's white logo
Patient-Friendly & Physician-Owned
CONTACT
Phone: (316) 634-0090
Fax: (316) 634-0005

2770 N. Webb Road
Wichita, KS 67226
QUICK LINKS
  • PATIENT INFO
    • NEW PATIENT INFORMATION
    • JOINT SEMINAR
    • ACCOMMODATIONS
    • FINANCIAL PLANNING
    • PRICE TRANSPARENCY
    • SELF PAY OPTION
    • PAY ONLINE
    • PATIENT PORTAL ACCESS
    • HEARTLAND GRILL
  • ABOUT US
    • OUR PHYSICIANS
    • AWARDS & CERTIFICATIONS
    • TESTIMONIALS
    • KSRC IN THE COMMUNITY
    • EMPLOYMENT
    • Employee Resources
  • SERVICES
    • TOTAL JOINT SURGERY
    • TOTAL KNEE SURGERY
    • TOTAL HIP SURGERY
    • TOTAL SHOULDER SURGERY
    • BREAST CARE SURGERY
  • CONTACT
INFORMATION
• Privacy Policy
• Ownership Disclosure
• Discrimination Policy
• CJR  Model  Notification
• Price Transparency

• Surprise Billing Notice

• 2021 TY  CHNA

• 2025 TY  CHNA

• CHNA Implementation Strategy 2021

• CHNA Implementation Strategy 2022
• Sitemap
Kansas Surgery And Recovery Center white logo
Patient-Friendly & 
Physician-Owned
CONTACT

Phone: (316) 634-0090
Fax: (316) 634-0005
2770 N. Webb Road
Wichita, KS 67226
INFORMATION

Privacy Policy
Ownership Disclosure
Discrimination Policy
CJR Model Notification
Sitemap
© 2025 

All Rights Reserved | Kansas Surgery & Recovery Center

web design powered by Silvergear
©2018 Kansas Surgery & Recovery Center
web design powered by Silvergear
Share by: