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Records Request

New Birth Company > Records Request
  • Consent to Obtain Records

  • Request for Prenatal Records


  • I am requesting a copy of my prenatal records including:

    Demographics | History & Physical | Lab | Ultrasound | Prenatal Flow Sheets | Encounters | Consults | Other Diagnostics
  • Please forward to:

    New Birth Company, 9209 West 110th Street Building #36, Overland Park KS 66210
    Phone: 913.735.4888
    Fax: 1.888.927.5843
  • Please forward to:

    New Birth Company, 721 North 31st Street #100, Kansas City KS 66102
    Phone: 913.802.2325
    Fax: 1.913.725.0573
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • At this time, I understand that this authorization may be revoked in writing by me at any time, except to the extent that this action has been taken. I understand that any release which was made prior to my revocation in compliance with this authorization shall not constituent a breach of my rights to confidentiality. I also understand that if the requestor or receiver of my medical records is not a health plan or health care provider, the released information may no longer be protected by federal privacy regulations and may be re-disclosed. This authorization will automatically expire one year from the date of signature.

  • Date Format: MM slash DD slash YYYY

Incredible Birth Days Start Here

Attend virtual orientation

Overland Park

9209 West 110th Street, #36
Overland Park, KS 66210
tel: (913) 735-4888
fax: 1-888-927-5843

Kansas City, KS

721 North 31st Street, #100
Kansas City, KS 66102
tel: (913) 802-2325
fax: 1-913-725-0573

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