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  • Junction City & Chapman: 785-238-4711
  • Manhattan: 785-320-7134

Patient Forms

Medical | Dental | Behavioral Health Forms

  • New Patient Packet (online)
  • New Patient Packet (printable)
  • Authorization to Release Information
  • Discount Fee Application
  • Patient Information Update
  • Patient Rights & Responsibilities
  • Notice of Privacy Practices
  • Acknowledgement of Policies
  • Minor/Child Consent to Treat

Formularios Médicos | Dentales | Salud Conductual

  • Paquete para nuevos pacientes (en línea)
  • Paquete para nuevos pacientes (imprimible)
  • Autorización para divulger información
  • Descuento de la tasa app
  • Derechos y responsabilidades del paciente
  • Aviso de prácticas de privacidad
  • Reconocimiento de políticas

Discounted Fee Schedules

  • Discount Fee Scale – Medical & Behavioral Health
  • Discount Fee Scale – Dental
  • Discount Fee Scale – Family Planning
  • Programa de Descuento de Tarifas – Médicos y Salud Conductual
  • Programa de Descuento de Tarifas – Dental
  • Programa de Descuento de Tarifas – Planificación Familiar

Questions?

Call and speak to one of our experienced, friendly staff who can help answer your questions.

  • Junction City & Chapman: 785-238-4711
  • Manhattan: 785-320-7134

Your Health is Our Top Priority

Request an Appointment today and we promise to help you with every issue you may have
Request an Appointment

konzaprairie@kpchc.org

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Our Locations:

  • Junction City
  • Manhattan
  • Chapman

Konza Prairie Community Health Center is a Nonprofit 501c3 Federally Qualified Health Center and a Federal Tort Claims Act (FTCA) deemed facility.

Patient Rights & Responsibilities 

Privacy Practices

konzaprairie@kpchc.org

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Quick Nav

  • Home
  • About
  • Services
  • Contact

Our Locations:

  • Junction City
  • Manhattan
  • Chapman

Konza Prairie Community Health Center is a Nonprofit 501c3 Federally Qualified Health Center and a Federal Tort Claims Act (FTCA) deemed facility.

Patient Rights & Responsibilities 

Privacy Practices

Copyright © Konza Prairie Community Health Center. All Rights Reserved. | Privacy Policy | Terms of Service | Disclaimer

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Navigation

  • Home
  • COVID-19
  • Patients
    • New Patients
    • Patient Forms
    • Patient Portal
    • Paying For Care
  • Services
    • Behavioral Health
    • Community Outreach
    • Dental
    • Family Planning | Reproductive Health
    • Interpreter Services
    • Medical
    • Medication Assisted Treatment (MAT)
    • Pharmacy
    • WIC
  • Careers
    • Clinic Staff
    • Dental Careers
  • Who We Are
    • Leadership
    • Meet Our Care Team
    • News
    • Who We Are
  • Contact
    • Location & Hours
    • After Hours Care

Location & Hours

Patient Portal

Pay Online

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