Axtell Clinic
Axtell Clinic Wichita Kansas
Axtell Clinic Wichita Kansas
Axtell Clinic Wichita KS
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As a new patient, you can download these forms at home, read and fill them out at your convenience, then bring them to your appointment. Doing so can often reduce the waiting time for your first visit. 

New Patient Information

Authorization to Disclose Information (required for all new patients)
Notice of Privacy (required for all new patients) [Updated August 2015]
Past History Form (for Patients of Dr. Glover, Dr. Slechta, and Dr. Hartvickson)
KSHSAA Physical Exam
Financial Policy [Updated June 2015]

Ophthalmology

New Patient Check In Sheet

Eye Medication Information Sheets
Beta Blockers for the Treatment of Glaucoma
Alpha Agonists for the Treatment of Glaucoma
Prostaglandin Analogs for the Treatment of Glaucoma
Carbonic Anhydrase Inhibitors (CAIs) for the Treatment of Glaucoma

More Ophthalmological Information
Amsler Grid and Instructions
Contact Lens Risk Information
Floaters and Flashes
Fluorescein Angiography
YAG Laser Posterior Capsulotomy

Obstetrics

Forms For Initial Obstetrics Visit

Employment

Application for Employment

 
 

Patient Portal

Log in to our Axtell Clinic Patient Portal to access medical records, update your information, schedule an appointment, or contact your nurse or physician!


Patient Portal

Log in to our Eye Center Patient Portal to access medical records or contact Dr. Beck and his staff!



 

Axtell Clinic  •  (316) 283-2800  •  Toll-Free (800) 232-8355  •  Fax (316) 283-3575  •  700 Medical Center Dr., Ste. 210  •  Newton, KS 67114-9017
Axtell Eye Center  •  (316) 804-4705  •  Fax (316) 804-4710  •  700 Medical Center Dr., Ste. 210  •  Newton, KS 67114-9042
Providers  |  History  |  Areas of Practice  |  Research  |  Forms  |  Eye Care  |  Contact/Location