Patient Forms

Medical Records

If you would like to request a copy of your medical records, please download the appropriate form and return to the appropriate location.

The Birth Place

The Birth Place pre-registration form should be completed and returned to the Birth Place Pre-admission Coordinator, or faxed to the Admissions Office at 913-791-4454. To make a pre-admission appointment, please contact the scheduling office at 913-791-3500, ext. 4128. Patients are encouraged to make their appointments between the 30th and 33rd week of pregnancy.

Patient Registration (New OMSI Clinic Patients Only) 

Save time by filling out new patient forms before your first clinic visit. Click here to complete the online registration form. List of OMSI clinics.

Rehabilitation Services

Based on the form(s) you were instructed to complete below, print the form, fill it out, then bring it with you to your first therapy appointment.  Thank you!

  • Registration Form
    To be completed by patients before coming for outpatient Physical Therapy, Occupational Therapy, or Speech Language Pathology.
  • PT-OT Intake Form
    To be completed by patients coming for outpatient Physical Therapy and Occupational Therapy
  • Women's Health Intake Form
    To be completed by patients coming to Physical Therapy specifically for women's health issues, such as back pain during pregnancy, pelvic pain and/or urinary incontinence issues.
  • Men's Health Intake Form
    To be completed by patients coming to Physical Therapy specifically for men's health issues, such as pelvic pain and/or urinary incontinence issues.
  • Vestibular (Dizziness) Intake Form
    To be completed by patients coming to Physical Therapy specifically for vestibular (dizziness) problems.
  • SLP Outpatient Intake Form
    To be completed by patients before coming for Speech Language Pathology (Speech Therapy).
  • Lymphedema Intake Questionnaire
    To be completed by patients coming for therapy for lymphedema.

Financial Assistance

Pre-Operation for Surgical Services

If you are scheduled for an upcoming surgical procedure at Olathe Medical Center, please download the appropriate form below. The pediatric form is for patients 13 years of age and younger.