Blue Springs
205 NW R.D. Mize Rd.
Suite 304
Blue Springs, MO 64014
Phone: (816) 228-4770
Fax: (816) 228-1156
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Independence
11200 Winner Road
Independence, MO 64052
Phone: (816) 228-4770
Fax: (816) 228-1156
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Appointments: (816) 655-0102
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Patient Forms
If you are a new patient, you may choose to print the new patient forms and fill them out prior to your appointment. Please bring the completed forms to your first visit.
- New patients with commercial insurance should complete the following forms:
- New patients with insurance through the state (i.e. Medicaid) should complete the following forms:
If you are an established patient and you have had an address or insurance change, you may be required to complete the Patient Information Form again.
If you would like copies of your child's medical records, please contact us by phone or through the patient portal. If you request that your child's records be transferred, you will need to complete the Medical Records Release form and return it to us by fax, mail or in person.
As always, please call us if you have any questions about completing these forms.
Download Adobe Reader What's New?
Urgent Care is now open 7 days a week in both of our locations.
Press Release: Cockerell & McIntosh Pediatrics earn national recognition.
We now accept Healthcare USA (Medicaid Managed Care plan)
AAP Speaks Out Against Retail-Based Clinics
Connect with us anytime through the Patient Portal. Online Billpay now available.
We're now on Facebook.
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