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Center for Telemedicine & Telehealth
 

Telemedicine Clinic Forms

We have reconfigured our consultation form request system. All necessary paperwork is now incorporated into these PDF files. Our goal is to make these forms as easy as possible to manage and print. As always, please resist the temptation to save these files for future use. These forms may be updated without warning, and we strongly recommend using only most recent version of each.

If the patient is new to this clinic, or has not been seen for a year or longer, please use one of the "New Patient Packets" from the first list.

New Patient Packets

Clinic Name English Spanish
ADC ADC NP English Packet ADC NP Spanish Packet
Adult Neurology Adult Neurology NP English Adult Neurology NP Spanish
Adult Psychiatry Adult Psychiatry NP English Adult Psychiatry NP Spanish
Adult Psychology Adult Psychology NP English Adult Psychology NP Spanish
Adult TeleHelp Adult TeleHelp NP English Adult TeleHelp NP Spanish
Diet & Nutrition Diet & Nutrition NP English Diet & Nutrition NP Spanish
Dr. Sonnenschein Sonnenschein NP English Sonnenschein NP Spanish
Healthy Hawks Healthy Hawks NP English Healthy Hawks NP Spanish
Pain Management Pain Management NP English Pain Management NP Spanish
Pediatric Neurology Ped Neurology NP English Ped Neurology NP Spanish
Pediatric Psychiatry Ped Psychiatry NP English Ped Psychiatry NP Spanish
Pediatric Psychology Ped Psychology NP English Ped Psychology NP Spanish
Pediatric TeleHelp Ped TeleHelp NP English Ped TeleHelp NP Spanish

If the patient has been seen more recently, please select one of the "Follow-Up Packets" from the second list.

Follow-up Packets (Established Patients)

Clinic Name English Spanish
ADC ADC FU English Packet ADC FU Spanish Packet
Adult Psychiatry Adult Psychiatry FU English Adult Psychiatry FU Spanish
Adult Psychology Adult Psychology FU English Adult Psychology FU Spanish
Adult TeleHelp Adult TeleHelp FU English Adult TeleHelp FU Spanish
Diet & Nutrition Diet & Nutrition FU English Diet & Nutrition FU Spanish
Dr. Sonnenschein Sonnenschein FU English Sonnenschein FU Spanish
Healthy Hawks Healthy Hawks FU English Healthy Hawks FU Spanish
Pain Management Pain Management FU English Pain Management FU Spanish
Pediatric Psychiatry Ped Psychiatry FU English Ped Psychiatry FU Spanish
Pediatric Psychology Ped Psychology FU English Ped Psychology FU Spanish
Pediatric TeleHelp Ped TeleHelp FU English Ped TeleHelp FU Spanish

Further questions:

If you have additional questions about telemedicine and how to participate, please contact:

Ryan Spaulding, PhD

Director, KU Center for Telemedicine & Telehealth

email: rspaulding@kumc.edu

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