Patient Forms

Success is where preparation and opportunity meet. – Bobby Unser

For your convenience, many of our forms are available to download in Adobe PDF format. To save time please print and bring the completed documents with you to your first appointment. If you have questions about which forms you will need for your appointment, please contact:

New patients/co-learners: please call our New Patient Coordinator at 316.927.4765
Existing patients/co-learners: please call our Wichita office at 800.447.7276

Thank you and we look forward to seeing you at your appointment!

Appointment Forms

  • New Patient Intake Forms

    Intake and medical history form. (Call our New Patient Coordinator at 316.927.4765 if you would like a paper copy mailed to you)
    Download
  • Appointment Instructions

    Information about your first appointment
    Download
  • Notice of Privacy Practices

    Explanation of how your medical information is used and disclosed and how to get access to it.
    Download
  • Rights and Responsibilities

    Explanation of your roles as a co-learner and the Riordan Clinic’s role as a provider. Included are our policies on: ...
    Download
  • Permission to Discuss

    Allows us to communicate with your health care providers, family and others when medically appropriate.
    Download
  • Records Request

    Request to obtain confidential information
    Download
  • 3 Day Diet & Exercise Log

    Keep a diary of your exercise and diet using this 3-day log sheet.
    Download