Your First Visit

Jon Jantz, MD

Cottonwood Pediatrics

700 Medical Center Drive, Suite 150

Newton Kansas 67114

Phone: 316-283-7100

Fax: 316-283-7118

Office Hours

Monday  -  Friday

8:00 am - 12:00 noon

1:00 pm - 5:00 pm

After hours: call 283-2700 and

ask to have your child's health care

provider paged

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WHAT TO BRING TO YOUR FIRST APPOINTMENT

  At your first appointment, you will need:
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your insurance card (bring this to every appointment)

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a co-payment, if your insurance requires one

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the patient's date of birth

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your child's social security number (and the social security numbers of any other children you would like for us to enter into our system)

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the social security number of the person whose health insurance you are using

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the social security number of the parent who is bringing the child to the appointment

 

   
Transfer Medical Records The "Grandma" Consent The "Teenager" Consent

Your child may have previously received care from another provider at another clinic or office.  These records are not automatically transferred to our office.  If you wish to have records transferred from another office, we have a release prepared that can be used. 

You may download the release form by clicking here, fill it out and take or mail it to your child's previous health care provider.  Some health care providers may charge for this service.

Is grandma bringing your child to an appointment while you are at work?  You may give a caregiver permission to have your child seen at our office. 

This permission can be given for up to a year at a time.

Download this Temporary Consent to Treat by clicking here

Fill it out and mail or fax to our office at 316-283-7118 BEFORE your child's appointment to avoid any delays in treatment.

If your child is at least 16, he/she may consent to his/her own treatment.  You can send your child to the clinic for routine treatments and exams without you. 

This consent must be renewed each year.

Download this Annual Consent to Treat by clicking here.

Fill it out and mail or fax to our office at 316-283-7118 BEFORE your child's appointment to avoid any delays in treatment. 

 

Downloading these forms requires you to have Adobe Reader.  If you do not have Adobe Reader, click on the icon to the right to download this free program.     

 
     

Copyright 2004-2011 Cottonwood Pediatrics. All rights reserved.

This page last updated:12/14/11

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