:: Patient Resources ::
Summit Rehab
Create Your Badge
As a new Patient, your time is very valuable to us
Please take a moment to review and complete the
following
forms:
You have the option to print and complete the forms
manually
complete them digitally and print
Please fill out these forms prior to your first
appointment and
either:
Privacy Notice
(read only)
General Information Form
Bill of Rights
Health History
Pelvic Floor
Screening
(
f
emale
)
Pelvic Floor Screening
(male)
email to
rh@summitrehabkc.com
print and bring them with you to your initial
evaluation
Connect
with
Summit Rehab
294 NE Tudor Road Lee's Summit, MO 64086
phone: 816-554-6003 fax: 816-554-6013
www.summitrehabkc.com