Forms
New Patient Forms: please download and fill out the new patient forms prior to your first visit.
Telemedicine (Virtual Visit) Consent Form
Telemedicine Consent Form.pdf
Adobe Acrobat document [816.6 KB]
Telemedicine Consent Form.pdf
Adobe Acrobat document [816.6 KB]
Release of Information Form
Release of Information to a family membe[...]
Adobe Acrobat document [218.0 KB]
Release of Information to a family membe[...]
Adobe Acrobat document [218.0 KB]
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.
(Virtual Visits)
(Patient Portal)
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 | |
| Thurs |
8am - 5:00pm |
|
| Fri | 8am - 3:30pm | |
| Sat |
8am - 10am |
Hours may vary based on provider availability. Hours subject to change. Please call for scheduling.
(COVID-19 Pandemic may affect hours.)
Lab Hours
| Mon | 8am - 1pm | |
| Tues | 2pm - 4pm | |
| Wed | 8am - 1pm | |
| Thur | 2pm - 4pm | |
| Fri | 8am - 1pm | |
| Sat | Lab Closed |
(COVID-19 Pandemic may affect hours.)
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