Contact Us

(913) 825-3627

Forms are an important part of your child’s care, and whether you’re preparing for a visit, requesting records, or completing a consent form, we’ve made the process simple and stress-free. On this page, you’ll find everything in one place, from physical forms and developmental questionnaires to vaccine consents and medical records requests. We’ve also included details about form fees, submission options, and downloadable resources to help ensure your paperwork is completed accurately and returned on time.

Leawood Pediatric Forms

Please complete the Paperwork Request Form and include with your documents to ensure timely return & accurate processing of your paperwork.
The card on file will be charged unless other arrangements are made.
There is no charge for forms completed during your child’s well visit, with the exception of FMLA forms (see details below)

Form Fees Outside of a Well Visit

  • $10 – Standard form, completed within 7–10 business days from the date of payment

  • $25 – Rush form, completed within 48 hours from the date of payment

  • $40 – FMLA or other extensive paperwork, completed within 7–10 business days from the date of payment

These fees reflect the time required by both staff and physicians to review and complete the paperwork. Please see our financial policy for more details.

Submitting Forms

If you need a form completed outside of a well visit, you may:

  • Drop it off at our front desk
  • Send it through your patient portal
  • Mail it to: 5401 College Boulevard, Suite 101, Leawood, KS 66211

  • Fax it to: (913) 948-9128

If forms are sent by mail, email, or fax, the card we have on file will be charged the applicable fee unless you make other arrangements with our front desk staff.

Need to Request Paperwork?

Please complete the Paperwork Request Form and include with your documents to ensure timely return & accurate processing of your paperwork.

Sports Physical Forms – KS and MO

Medical history form must be completed by student and parent/guardian prior to physician completing.

KSHSAA Physical Form
MSHSAA Physical Form

Medical Records

  • We are happy to assist with medical records requests. To request records, please complete our Medical Records Request Form.

  • Please allow up to 30 days for processing.

  • Basic medical records may be requested at no charge

  • Full medical records requests are subject to a $25 fee.

  • If you would like to authorize another individual to access your child’s or your own medical information, please complete the appropriate delegation form below:

Downloadable Faqs

By agreeing to these terms and conditions you agree to receive automated marketing and informational SMS text messages from Leawood Pediatrics, An Affiliate of Children’s Mercy, Inc. These messages may include appointment reminders, payment reminders, and other information related to your account or services with us. The frequency of these messages will vary depending on the purpose but in no case will you receive more than 20 per month. You may opt out of these messages at any time by unsubscribing or informing us directly at 913-825-3627. Standard message and data rates may apply. You acknowledge that you have read and understood our Terms and Conditions and Privacy Policy

By submitting this form, I consent to receive SMS text messages from Leawood Pediatrics – An Affiliate of Children’s Mercy, Inc. for appointment reminders, marketing messages, and general two-way communication. Msg frequency varies. Msg&data rates may apply. Reply HELP for support. Reply STOP to opt out.
*Consumer information is not shared with third-parties for marketing purposes

Need Help with Your Forms?

Our team is happy to answer questions or assist with completing and submitting your paperwork.
Whether you’re preparing for a visit, requesting records, or sending in a form, we’re here to help make the process easy.

Contact Our Office for Assistance
Text Us