equipoise logo

 8110 e 32nd st n  ❃ suite 170  ❃  wichita, ks  ❃  67226  ❃  316-330-9700

  • home
  • services
    • general pediatrics primary care
    • pediatric hematology
    • pediatric oncology
    • rare disease consultation and care
    • palliative care
  • about us
  • contact us
  • careers
equipoise logo

 8110 e 32nd st n  ❃ suite 170  ❃  wichita, ks  ❃  67226  ❃  316-330-9700

  • home
  • services
    • general pediatrics primary care
    • pediatric hematology
    • pediatric oncology
    • rare disease consultation and care
    • palliative care
  • about us
  • contact us
  • careers

patient forms

patient & caregiver resources

  • disease information
    • bleeding disorders
    • blood clots
    • blood transfusions
    • bone marrow failure syndromes
    • brain and spinal tumors
    • childhood cancer
    • G6PD deficiency
    • hemolysis
    • immune thrombocytopenia
    • iron deficiency
    • lead toxicity
    • leukemia and lymphoma
    • lymphadenopathy
    • neutropenia
    • sickle cell
    • solid tumors
    • survivorship
    • thalassemia
    • transient erythroblastopenia of childhood
  • research
  • FAQ
  • helpful links
  • patient portal
  • patient forms
  • services
    • general pediatrics primary care
    • pediatric hematology
    • pediatric oncology
    • rare disease consultation and care
    • palliative care
EMERGENCY INSTRUCTIONS when to call for help

patient forms

new patient forms
release of information
authorization to accompany a minor
notice of privacy practices (HIPAA)

new patient forms

download and print

1. updated intake form 5. authorization for a minor to be accompanied by adults who are not their legal guardians
2. financial policy
3. HIPAA authorization
4. authorization for release of medical records
1. updated intake form
2. financial policy
3. HIPAA authorization
4. authorization for release of medical records 5. authorization for a minor to be accompanied by adults who are not their legal guardians

note: equipoise's privacy practices can be found by clicking the "notice of privacy practices (HIPAA)" button here or at the top of the page; this information is here for your reference, but is not necessary to print unless you want a copy for your records.

notice of privacy practices (HIPAA)
equipoise logo
Helping families fight cancer with hope and dignity.
Rainbow triangle icon

hours

monday-friday

9:00 am - 4:30 pm


quick links

  • home
  • about us
  • contact us
  • careers
  • EMERGENCY INSTRUCTIONS
  • employee resources

caregiver resources

  • services
    • general pediatrics primary care
    • pediatric hematology
    • pediatric oncology
    • rare disease consultation and care
    • palliative care
  • patient portal
  • patient forms
  • FAQ
  • helpful links
  • research

contact

(316) 330-9700
info@equipoisehealthcare.com
8110 e 32nd st n  ❃  suite 170
wichita, ks  ❃  67226
fax: 316-330-9701
equipoise logo
Helping families fight cancer with hope and dignity.
Rainbow triangle icon

quick links

  • home
  • about us
  • contact us
  • careers
  • EMERGENCY INSTRUCTIONS
  • employee resources

caregiver resources

  • services
    • general pediatrics primary care
    • pediatric hematology
    • pediatric oncology
    • rare disease consultation and care
    • palliative care
  • patient portal
  • patient forms
  • FAQ
  • helpful links
  • research
  • disease information
    • bleeding disorders
    • blood clots
    • blood transfusions
    • bone marrow failure syndromes
    • brain and spinal tumors
    • childhood cancer
    • G6PD deficiency
    • hemolysis
    • immune thrombocytopenia
    • iron deficiency
    • lead toxicity
    • leukemia and lymphoma
    • lymphadenopathy
    • neutropenia
    • sickle cell
    • solid tumors
    • survivorship
    • thalassemia
    • transient erythroblastopenia of childhood

contact

(316) 330-9700
info@equipoisehealthcare.com
8110 e 32nd st n  ❃  suite 170
wichita, ks  ❃  67226
fax: 316-330-9701

hours

monday - friday
9:00 am - 4:30 pm
equipoise logo
Helping families fight cancer with hope and dignity.
Rainbow triangle icon

quick links

  • home
  • about us
  • contact us
  • careers
  • EMERGENCY INSTRUCTIONS
  • employee resources

caregiver resources

  • services
    • general pediatrics primary care
    • pediatric hematology
    • pediatric oncology
    • rare disease consultation and care
    • palliative care
  • patient portal
  • patient forms
  • FAQ
  • helpful links
  • research
  • disease information
    • bleeding disorders
    • blood clots
    • blood transfusions
    • bone marrow failure syndromes
    • brain and spinal tumors
    • childhood cancer
    • G6PD deficiency
    • hemolysis
    • immune thrombocytopenia
    • iron deficiency
    • lead toxicity
    • leukemia and lymphoma
    • lymphadenopathy
    • neutropenia
    • sickle cell
    • solid tumors
    • survivorship
    • thalassemia
    • transient erythroblastopenia of childhood

contact

(316) 330-9700
info@equipoisehealthcare.com
8110 e 32nd st n 
❃  suite 170
wichita, ks  ❃  67226
fax: 316-330-9701

hours

monday-friday

9:00 am - 4:30 pm

© 2025 

All Rights Reserved | Equiposie Healthcare

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