Provider Portal
Children's Mercy Hospitals and Clinics

To refer a patient to one of the Children’s Mercy Hospitals and Clinics (CMH) Specialty Clinics, please click on the New Patient Appointment Form below.

  • Print this form and fax it with attachments, or submit it electronically and fax any attachments separately.
  • Forms requiring a signature must be printed, signed, and faxed.
  • Save or print a copy of this form before submitting it electronically.

Each patient is given a "next available" appointment slot. If the scheduled appointment is not soon enough, please notify the Contact Center.

Please note that Adobe Reader is required to view these forms.

* If you need to schedule two or more appointments on the same day for your patient, please contact the Physician Appointment Line in the Contact Center at (816) 234-3700 or (800) 800-7300 and ask for the "Provider Resource Nurse."

The following clinics have additional information regarding the referral process and/or additional forms to be submitted with the appointment request or prior to the appointment.

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