Request an
Appointment

Please use this secure form to request an appointment with one of our physicians or nurse practitioner.

Once submitted, this form will be securely sent to our office.

If you are a new patient, please call our office directly at 816-525-8500 for your appointment.

Patient Name

Date of Birth

Contact Name

Call Back Phone No.

Contact Email Address (for confirmation)

Insurance Carrier

Policy No.

Select the provider you would like to see
Gary McEwen, MD
Matthew McEwen, MD
Amber Kunshek, NP-C
Linh Nguyen, PA-C
No Preference

If your preferred provider is not available within this time frame, would you be willing to see a different provider?
Yes
No

What time would you prefer?
Morning
Afternoon
No Preference

Special Instructions

LuxSci helps ensure HIPAA-compliance for email and web services.

Call our office or 911 for immediate attention.

Request an Appointment

Request an
Appointment