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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
1.316.684.3838
1.800.657.7250

Copyright 2001 by Galichia   All rights reserved.   Term & Conditions