Patient Forms

Teenage girl smiling

The following forms are available to sign in the office:

  • Consent Form
  • Notice of Privacy Practice

You may access the following forms prior to your appointment. Please download, print, and complete the entire form. We ask that you then bring these forms to your first visit.


*These forms require Adobe Acrobat Reader. Click the Adobe logo above to download.

Mid American Treatment Center for TMD

  • Kansas - 818 N. Emporia, Suite 101, Wichita, KS 67214 Phone: 316-262-4863
  • Oklahoma - 8006 S. 101st East Ave, Suite C, Tulsa, OK 74133 Phone: 918-254-4865

2024 © All Rights Reserved | Website Design By: TelevoxLogin