New Patient Forms
New Patient Forms
Download our New Patient Forms directly to your computer.
Download Instructions
Download the file by clicking the button below. Open the file and click "Save As" and put your first initial and last name before the NP intake.
Go to the right side of the screen, or the top of the screen under "Tools" and click the "Fill and Sign" button.
Go through the entire form completing your answers or checking boxes, then sign the document when you are done. MAke sure that all of your typed answers are small enough font to be completely visible on the page.
When completed, send the document to records@mladenoffclinickc.com
“After 2 concussions in 2 months, my high school daughter was having side effects from prescription drugs and her symptoms were getting worse. The Doctors' at the Mladenoff Clinic found the causes of her problems, created a specific treatment protocol that had dramatic results.
She finished high school successfully, and has been on The Dean's Honor Roll every semester in college.
They are my concussion healers!”
Pamela W. Overland Park, KS
“I fell off a step ladder, hit my head and was unconscious. I missed 2 1/2 months of work. Two years later I continued to have memory and balance problems, headaches, trouble sleeping and concentrating. A neurologist said I has MS. I had a concussion and nobody was helping me.
I was skeptical about how much the doctors could help. AS a result of treatment strategies a follow-up MRI revealed decreased number of brain lesions and MS was not present.
I strongly recommend if you have had a concussion that you go to the Mladenoff Clinic to get help.”
Linda C. McKinney, TX
“I did the Amen Clinic protocol and several other brain based protocols to address my problems with day to day functioning. I had no clue that the Mladenoff Clinic had a comprehensive approach that has exceeded all of my. The doctors evaluated me more thoroughly than all of the clinics I have consulted. I would recommend the Mladenoff Clinic to anyone that is having trouble with brain fog, focusing and dealing with problems executing a a high level of success. You will be impressed.
Shannon S. Overland Park, KS