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]
Privacy Notice
Privacy Notice.pdf
Adobe Acrobat document [275.4 KB]
Medical Records Release Form
Medical_Records Release Form.pdf
Adobe Acrobat document [1.3 MB]
Release of Information Form
Release of Information to a family membe[...]
Adobe Acrobat document [218.0 KB]
Patient Demographic Form
PatientDemographics.pdf
Adobe Acrobat document [23.9 MB]
Past Medical History
PatientMedicalHistory.pdf
Adobe Acrobat document [16.1 MB]
Payment Policy
PaymentPolicy.pdf
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.

(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

 (Virtual Visits)

*Saturday hours available

for Virtual Visits/Telemedicine

only.

 

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

 

(COVID-19 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 may affect hours.)

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