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Dr. Thomas F. Bembynista

Patient Info

Scheduling Appointments

We realize that our patients' time is valuable, and we make every effort to see patients at their scheduled time. However, occasionally, our office falls behind schedule. We ask for your understanding; we, also, ask that patients provide as much advanced notice as possible when running late for an appointment or when needing to cancel. With this advanced notice, the time can be scheduled for another patient.

What to Bring to Your Appointment

If you are a first-time patient, please plan on arriving early in order to complete a patient registration form and please bring the following items to the appointment:

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Insurance and Payment Information

We are a provider for Medicare and most major insurance plans. Since we provide insurance billing, we encourage all patients to confirm their coverage prior to making an appointment. Co-payments are due at the time of the appointment, along with any applicable deductible payment. If the insurance company does not pay the full balance, or denies the claim, then any unpaid balance is due within 30 days following the appointment.

Please call us with any questions regarding which insurance plans we accept or other billing concerns. Insurance coverage and benefit questions should be directed to your insurance company.

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Hospital Affiliations

Dr. Thomas F. Bembynista maintains affiliations with the following hospitals:
  • St. Luke's North
  • Liberty Hospital
  • North Kansas City
  • Baptist Medical Center
  • Independence Regional Medical Center
  • Johnson County Surgical Center

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Welcome Sheet, History Form and Notice of Privacy Practices

Please arrive 15 minutes early for your first appointment to allow time to complete our welcome sheet, history form, and notice of privacy practices, or you may print and complete the forms at home prior to your visit.

Welcome Sheet, History Form, and Notice of Privacy Practices (PDF)

Troubleshooting:
If you have trouble accessing the PDF form above, go to
PDF Help >>

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Dr. Thomas F. Bembynista
Independence office
10612 E 18 St
Independence, MO 64052
Tel: 816.461.7755
Fax: 816.461.0393
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Overland Park office
10550 Quivira Road
Suite 260
Overland Park, KS 66210
Tel: 913.894.0660
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Baptist Medical Center office
6724 Troost Avenue
Suite 302
Kansas City, MO 64131
Tel: 816.523.3033
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Barry Road office
5820 N.W. Barry Road
Suite 400
Kansas City, MO 64154
Tel: 816.455.3636
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