Request an Appointment Please call 816.648.6482 (MIVA) or complete the form below to request an appointment or consultation. Appointment First Name*Last NamePrimary Insurance*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*Patient Type* New Patient Existing Patient This field is hidden when viewing the formPreferred PhysicianPreferred PhysicianDr. Charles NuttingDr. Aaron KovaleskiPlease download and complete the New Patient Information Form and bring it with you to your appointment.How did you hear about us?Please log in to the Patient Portal for access to important information.Appointment Requirements*Once you submit this form, our front office will be in touch within 1 business day to schedule your appointment.CAPTCHANameThis field is for validation purposes and should be left unchanged.