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Filling Out a Medical Form

Forms

As you prepare for your appointment, you may be interested in filling out necessary paperwork in advance to save time in the waiting room. Our forms are fillable .pdf files, allowing you to input your information, save the .pdf as a new file, and send to either of our amazing receptionists. 

Patient Demographics

Records Release 

DOT Physical

Aviation Physical

Once you have input all of your information into the file, please save the .pdf to your computer or device, and then email either to clinicreception@kdhks.com. 

© 2021 Kiowa District Healthcare

1002 South 4th Street, Kiowa Kansas

Tel: 620-825-4131

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Please make checks payable to

Friends of KDH & Manor Foundation

Tax ID# 36-4678628

1002 S 4th St.| P.O. Box 184| Kiowa, KS  67070

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