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Children's Mercy logo in blue and yellow. Includes adult with dancing child icon.

Welcome to the Children's Mercy Request Forms

Please select an available form from the list below


  • New Supplier Registration Form
  • Guarantor Change Request Form
  • New Patient Appointment Form
  • Marketing Photo Release Forms
  • Adoption Assistance Reimbursement Request Form
  • COVID Drive-up Testing
  • Financial Assistance Application
  • Financial Assistance Additional Attachments Form
  • Healthy Homes Repair Program Application
  • Healthy Homes Additional Attachments
  • Healthy Homes Tenant Enrollment Form
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For patients and families
(816) 234-3000
Toll Free
(866) 512-2168
For providers: urgent consults, admissions, transports
(800) GO MERCY
(800) 466-3729
For deaf/hard of hearing callers
TTY - 711

Children’s Mercy is the first health care system in MO or KS to receive 6 consecutive Magnet® Designations.
Learn more about Magnet Recognition.

U.S. News & World Report. Voted one of America's best children's hospitals. Ranked in all 11 specialties.
Learn more about our rankings.

Built for Kids™

Your gift today brings hope, comfort and the prospect of brighter tomorrows to children and their families.

Children’s Mercy is a 501(c)3 charitable organization.

Make a Gift Icon at Children's Mercy Donate now
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2401 Gillham Road, Kansas City, MO 64108
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