Skip to content
Ashley Clinic
Call Us (620) 431-2500
MENUMENU
  • About Us
    • About Us
    • Careers
    • Health & Wellness News
    • Leadership Team
    • Locations
    • Student Experience Opportunities
  • Meet Our Physicians
  • For Patients
    • IMH Pre-Visit Interview
    • Make a Payment
    • Patient Forms
    • Patient Portal
    • Resources
    • Scheduling
      • Chanute Scheduling
      • Humboldt Scheduling
      • Iola Scheduling
      • Yates Center Scheduling
  • Services
    • Bioidentical Hormone Replacement Therapy (BHRT)
    • Botox
    • Clinical Therapy
    • Convenient Care Walk-In Clinic
    • Dermal Fillers
    • Diabetes Education
    • Family Medicine
    • Imaging Services
    • Immunizations
    • Laboratory
    • Medication-Assisted Treatment (MAT)
    • Microneedling
    • Pediatrics
    • Pharmacy
    • Sneak Peek 3D/4D Sono
    • SneakPeek Early Gender DNA Test
    • Spravato®
    • Surgery
    • Urology
    • Wound Care
  • Patient Portal
  • Make a Payment

For Patients

IMH PRE-VISIT INTERVIEW - PATIENTS OF DR. ROBERT THOMEN OR KATHI YOKUM, APRN

The IMH Pre-Visit Interview can be completed by following the link to the right. Please complete the interview prior to your appointment if possible. 

COMPLETE THE INTERVIEW

PATIENT FORMS​

General Forms

  • Authorization for Disclosure of PHI
  • Consent to Treat a Minor
  • KSHSAA Pre-Participation Physical Evaluation
  • Medical Records Request Form
  • Non-Discrimination Policy
  • Notice to Medicare Beneficiaries (Spanish)
  • Patient Rights and Responsibilities
  • Permission to Share
  • Privacy Policy
  • Sliding Pay Scale

Biote Forms

  • Female Biote Paperwork
  • Male Biote Paperwork

RESOURCES

Brochures

  • Ashley Clinic General Services
  • Convenient Care
  • Family Caregiver Support Program
  • Healthy Habits to Better School Performance
  • Measles Information
  • Medication-Assisted Treatment (MAT)
  • Southeast Kansas Mental Health Center General Services
  • Tips For Talking About Your Mental Health

Transportation Options

Allen Regional Transit (ART) offers public transit to residents in Allen Co. and non emergent out of county. You can reach them at 620-228-0463.

Locations

Chanute

Humboldt

Humboldt Specialty Clinic

Iola

Yates Center

Medical Records

Phone: 620-431-5602
SFax: 620-431-4850

connect with us

  • Facebook
  • YouTube
  • TikTok
  • Instagram
  • LinkedIn

We do not discriminate. View our policy here. Free language assistance services available.
© 2025 Ashley Clinic, LLC All rights reserved.