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mtmkc.com

Paperwork Instructions:

New patient paperwork must be completed and

returned to the office at least 1 week prior to your first appointment. 

Please complete the appropriate Information Packet; the Signature Page for Consent and Agreement; and the Consent to Release Protected Health Information, if needed. To return paperwork you may send it via secure email to info@mtmkc.com or drop it off to the office at at scheduled time. 

 Should you have any questions, please call or email Faith our Administrative Assistant for further assistance!

Child Information Packet

Download PDF

Adult Information Packet

Download PDF

Consent to Release Protected Health Information

Download PDF

Signature Page for Consent and Agreement

Download PDF

Policies and Procedures

Notice of Privacy Practices for Protected Health Information

Policies and Procedures Agreement

Use of Medication for Treatment Agreement

Download PDF

NICHQ Vanderbilt Assessment Scale Teacher

Download PDF

NICHQ Vanderbilt Assessment Scales Parent

Download PDF

Adult ADHD Self-Report Scale

Download PDF

Connors Questionnaire and SNAP-IV Rating Scale

Download PDF

  • Patient Forms

Minds that Matter

14221 Metcalf Avenue Suite 123, Overland Park, Kansas 66223, United States

913-912-7054

Copyright © 2025 Minds that Matter - All Rights Reserved.

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