Physical Forms
Please download and fill out the forms/questionnaires below prior to you physical and bring with you to your appoinment.
School Physical Forms
Below you will find available for download the Pre-Participation Physical Evalution (PPE) form your child needs for their school physicals. Please fill out the front page before your visit.
Medicare Annual Health Update
Please download the packet below and fill out in it's entirety to best of your ability. Return the completed packet back to the clinic before your scheduled visit date with you provider. This packet includes both files below. Thank You
Medicare Health Update Visit.pdf
Adobe Acrobat document [713.9 KB]
Adobe Acrobat document [713.9 KB]
PHQ9 Questions.pdf
Adobe Acrobat document [483.5 KB]
Adobe Acrobat document [483.5 KB]
Where to Find Us
606 N Mulberry Rd
Derby, KS, 67037
Phone: (316)788-3787
Fax: (316)788-2618
Clinic Hours
| Mon | 7am - 5pm | |
| Tues | 7am - 5pm | |
| Wed | 7am - 5pm | |
| Thurs |
7am - 6pm |
|
| Fri | 7am - 3:30pm | |
| Sat |
Closed |
Lab Hours
| Mon | 8am - 1pm | |
| Tues | 12pm - 4pm | |
| Wed | 8am - 1pm | |
| Thurs |
12pm - 4pm |
|
| Fri | 8am - 1pm | |
| Sat |
Closed |
Print