(913) 728-0997 ContactUs@MMjCCC.com

Intake Form

If you have medical records, or you are sure you will have them by your preferred appointment time, complete this form to confirm that you have a qualifying condition and that you consent to being seen as a patient.

To complete the Intake Form, click HERE.

During the COVID-19 Crisis we are offering telemedicine visits only, by appointment only.

107 West Ninth Street 2nd Floor Kansas City Missouri 64105.