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  If this is your first time appointment or you are new patient for clinic, print and fill out all the forms below link. Please bring them with your appointment. Thank you!  
  * Patient Registration Form  
  * Assignment of Benefits - Financial Responsibilities  
  * Patient Financial Policy  
  * Patient Health History Questionnaire  
  * Patient Health History Questionnaire Instruction Sheet  
  * Notice of Privacy Practies  


Galichia Medical Group, P.A.
2600 N Woodlawn
Wichita, KS 67220

Copyright 2001 by Galichia   All rights reserved.   Term & Conditions