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KLS Central Intake Line
316-267-3975
Phones are answered
8:00 a.m. to 4:30 p.m.
Monday through Friday.
Best times to call
If you call before 9 a.m. or between 12 p.m. and 12:30 p.m., you will have the shortest waiting time.
► This form is available to print in PDF or Word format at the bottom of this page.
REPORT OF EXAMINATION AND EVALUATION
By a □ physician □ psychologist □ social worker □ other: _____________________________ (In compliance with K.S.A. 59-3064)
Attach additional sheets as necessary.
(1) Date/Location of examination:_______________ , at ______________
(2) Name of proposed ward/conservatee:__________________________
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