The KidHeart Screening Program is a Limited Cardiac Pre-Participation Evaluation

History Form

Because of concern about sudden cardiac death in athletes, some parents want to have

their child screened for conditions which can cause Sudden Cardiac Arrest.

  • The American Academy of Pediatrics estimates as many as 2,000 under the age of 25 will die of SCA this year.
  • Sudden Cardiac Arrest (SCA) is the leading cause of sudden death in young athletes.
  • Heart conditions that trigger Sudden Cardiac Arrest are both detectable and treatable.

Our KidHeart Screening is a noninvasive testing process that is affordable, accurate and convenient. In most cases, early detection of problems allows children to live more normal lives.


What it is:

  • History
  • Form
  • Blood
  • Pressure Check
  • Electrocardiogram (ECG)
  • Focused Echocardiogram (Ultrasonic Heart Imaging)

What it is NOT :

  • A visit with the doctor
  • A physical exam
  • Discussion at the time of the visit about what the ECG and echocardiogram showed

Cost: $125

All forms of payment are accepted.

Payment due prior to screening.


Confidential results are delivered within 10 days to you and your
doctor after the completion of the screening. You will be contacted about the screening results. If the screening shows anything abnormal, further arrangements can be made for a
more in depth visit in our office.

* Note: No information will be submitted to insurance. Insurance information is not
collected for the KidHeart Screening program.*

Click on the link below for the history form. Please have this filled out as much as
possible prior to coming. We will fill out blood pressure, height and weight. We
recommend using Adobe Acrobat Reader.

History Form

Call our office to schedule your athlete’s KidHeart
Screening today!

Kansas City Pediatric Cardiology
(816) 584-0505
4150 N. Mulberry Drive, Suite 150
Kansas City, MO 64116
www.KCKidHeart.com