Family Intake
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We are pleased that you have chosen the Center for Child Health and Development to provide services for your child.

To begin the intake process, please complete the following form.

To complete this form you will need the patient's date of birth and insurance information (if using insurance including Medicaid) from the health insurance card for the patient. You will not be able to submit this form without providing this information.

Our intake process is the first step in the evaluation process. The information you provide will help us learn about your concerns and understand your child’s needs at this time. Keep in mind that you will also have the opportunity to provide more detailed information as the evaluation process moves forward.

Please do not skip any questions on the form. Incomplete applications will cause a delay in processing.

After your form has been successfully submitted, you will receive a confirmation email.

If you have questions, please call the University of Kansas Medical Center, Department of Pediatrics at 913-588-6300.

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