Printable Patient Paperwork for Your Convenience

Save yourself some time and fill out a few forms before you arrive for your appointment. Please click on the forms, print them, fill them out and bring them with you.

Printable Forms

Photo Authorization Form

Privacy Act

Medical Records Release (Please complete this form only if you need to transfer your records to us or need us to transfer your records elsewhere.)

Helpful Links

KanSmile

KanSmile Funding Application

Special Healthcare Needs

ACPA

Special Health Care Needs for Kansas

Patient Portal

If you’d like to manage your account online, please visit the patient portal: Click Here

Thank you for trusting the Kansas Cleft and Craniofacial Center with your care. Please bring your completed forms with you to your first consultation. We look forward to seeing you soon.

Your Child. Our Priority.