HOME STAFF REQUEST AN APPOINTMENT TELEMEDICINE RX REQUEST FORMS TESTIMONIALS PRIVATE. PROFESSIONAL. PERSONAL. Child, Adolescent, and Adult Psychiatry Services 4901 W. 136th St. Leawood, KS 66224 PH: 913-488-2012 FAX: 913-890-7285 COVID-19 UPDATE Offering telemedicine appointments to protect your health. We are accepting new patients! Please fill out our New Patient Intake Form or call (913) 387-2045 to set up a New Patient Appointment! ©2020 Geenens Psychiatry. Proudly made with wix.com

HOME STAFF REQUEST AN APPOINTMENT TELEMEDICINE RX REQUEST FORMS TESTIMONIALS NEW PATIENT INTAKE FORM Please fill out and submit the New Patient Intake Form. Once completed, our staff will be notified and will follow up with you for scheduling! PATIENT INFORMATON INSURANCE INFORMATION Insurance information is used for Prior Authorization purposes only. We do not accept insurance for appointment payments. Please upload a VALID form of ID here (i.e. Driver's License, Passport, etc.): Upload here I agree to the Terms of ServiceVIEW HERE I agree to the Controlled Medication AgreementVIEW HERE Submit Intake Form ©2020 Geenens Psychiatry. Proudly made with wix.com

HOME STAFF REQUEST AN APPOINTMENT TELEMEDICINE RX REQUEST FORMS TESTIMONIALS RELEASE OF INFORMATION (ROI) Please download and complete the following form. Once completed, please either mail the form to our office or email it to our Administrative Assistant, Arthur Clifford, at: arthurc@geenenspsychiatry.org. Thank you! ©2020 Geenens Psychiatry. Proudly made with wix.com

HOME STAFF REQUEST AN APPOINTMENT TELEMEDICINE RX REQUEST FORMS TESTIMONIALS TELEMEDICINE Please click on your medical provider's name to begin your telemedicine appointment. If you experience any problems, please call our office at 913-488-2012. Marissa Lahey, APRN-BC Dr. Douglas Geenens, D.O. Dr. Victoria Haynes, DNP ©2020 Geenens Psychiatry. Proudly made with wix.com