Patient Forms

Getting ready for your first appointment as a new patient with Heartland Cardiology is a breeze. Simply print out the following forms, complete them to the best of your ability and bring them along to your appointment.

Our Locations

3535 N. Webb Rd.
Wichita, KS 67226

Phone: 316-686-5300
Fax: 316-651-2660

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9000 W. Central
Wichita, KS 67212

Phone: 316-773-5300
Fax: 316-651-1579

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1719 E. Cambridge
Ste 101
Derby, KS 67037

Phone: 316-260-1550
Fax: 316-558-8286

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700 Medical Center Dr.
Ste 102
Newton, KS 67114

Phone: 316-686-5300
Fax: 316-333-1305

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Affiliate Hospitals

Wesley Medical Center
Wesley Woodlawn Hospital & ER
Via Christi Hospital St. Francis
Via Christi Hospital St. Joseph
Via Christi Hospital St. Teresa
Kansas Medical Center
Robert Dole VA Medical Center
Kansas Heart Hospital

Affiliate Partners

EPIC Heart & Surgery Center
Wichita Vascular & Vein Center

make an appointment

To schedule an appointment at any of our locations, please call 316-686-5300.

make an appointment