New Patient Paperwork

New Patient Forms: please download and fill out the new patient forms prior to your first visit.

Medical Records Release Form
Medical_Records Release Form.pdf
Adobe Acrobat document [1.3 MB]
Release of Information to a family membe[...]
Adobe Acrobat document [218.0 KB]
Patient Demographic Form
Adobe Acrobat document [23.9 MB]
Past Medical History
Adobe Acrobat document [16.1 MB]
Payment Policy
Adobe Acrobat document [24.3 MB]

For physicals and other visit forms please select the appropriate sub-pages to the left.

Please Note: It is not okay to copy and/or reproduce any form from this site for any use other than that for which it was originally intended.

Where to Find Us

Tanglewood Family Medical Center P.A.
606 N Mulberry Rd
Derby, Ks 67037

Phone: (316) 788-3787

Fax: (316) 788-2618


After Hours Physicians Exchange (316)262-6262

Clinic Hours

Mon     8am - 5:00pm
Tues   8am - 5:30pm
Wed   8am - 7:30pm

8am - 5:00pm

Fri   8am - 3:30pm

8am - 10am

Hours may vary based on provider availability. Hours subject to change. Please call for scheduling.  

Lab Hours

Mon          8am - 1pm
Tues   2pm - 4pm
Wed   8am - 1pm
Thur   2pm - 4pm
Fri   8am - 1pm
Sat   Lab Closed
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© Tanglewood Family Medical Center P.A.