Special Olympics Kansas Provider Directory Application
This form was created with the intent to build Special Olympics Kansas' reach within the medical field on behalf of our Healthy Athletes. Special Olympics Kansas is dedicated to creating an equitable and inclusive atmosphere that our athletes will feel comfortable and confident navigating. With just 15 minutes of your time, we will be able to provide them another resource that they may utilize after their initial health screenings with SOKS. Thank you for your efforts. 
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Establishment Name: *
Provider's Name(s): *
Mailing Address: *
Phone Number: *
Establishment Type (Check All That Apply): *
Required
Establishment Type: *
Required
Please choose the accessibility features available at this Establishment (Check All That Apply): *
Required
Days of Operation (Check All That Apply): *
Required
Hours of Operation: *
Fees/Payment Options (Check All That Apply): *
Required
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