New Patient Agreement Acceptance

By completing this form, you are agreeing to the terms of the  New Patient Agreement.

After completing this Acknowledgement, you will then be taken to the Living Matrix system where you will enter your health history.

A laptop or desktop computer is required. Living Matrix does not work with tablets or phones.

If you have any questions, please contact us at 913-642-1900.

  • Agreement Terms Acknowledgement:

    This document is not a contract. It is specifies the arrangement between HealthSpan and you, our patient or guardian of a patient, at the time you sign the document. We periodically review this agreement or update it at our discretion. We do our best to notify our patients of changes to this agreement before their next appointment. Unfortunately, it is not always possible to notify you of changes immediately, and receipt of notification cannot be guaranteed.

    As such, by signing below, you are acknowledging that you have read this document and agreeing that you will abide by terms stated therein, including any changes or additions we may make after the document is signed. You are also acknowledging that the document is not a contract and that we have the right to change anything in the document, as well as anything else referenced therein, at our discretion and without prior notice.
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  • This field is for validation purposes and should be left unchanged.
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