Telemedicine Consult Request

Complete the questions below and click "Request Forms" to download the needed forms.
Is this patient coming in for a Follow-up visit or a New Visit for this particular Telemedicine specialty clinic?
[A known patient being seen in a different specialty clinic is considered to be a "new visit"]
New Patient  Established Patient
What clinic do you need? Behavioral Psychology, ADHD, and Depression Center for Child Health and Development (CCHD) Diet and Nutrition KUMC Child Psychiatry Other Clinic Pediatric General Physical Therapy Sonnenschein Child Psychiatry Weight Management

    

Please note: "USD500" forms are no longer required. They might be listed on the fax cover sheet, but they are not included in the download and are not needed.