Contact Us

Physical Address:
Doctors Without Delay
Rooks County Health Center
1210 N. Washington, Clinic A
Plainville, KS 67663

Billing Address:
Doctors Without Delay
P.O. Box 407
Plainville, KS 67663

  Find us on Facebook




Phone:
785.688.DOCS (3627)
Toll Free: 855.688.3627

Fax:
785.688.3636

Email:
Please contact our office if you would like to sign up for a secure patient portal account. Because of privacy laws, we cannot manage patient correspondence through standard email.

Printable Forms
The forms below may be printed and completed before coming to Doctors Without Delay.

Patient Information Form
The Patient Registration Form is for new patients or those who need to update their address or insurance information. Please give the completed form to the receptionist when you arrive.

Patient Consent For Use and Disclosure of Personal Health Information
The Patient Consent for Use and Disclosure of Personal Health Information reviews Doctors Without Delay’s policies regarding how we safeguard your medical records. Please give the completed form to the receptionist when you arrive.

Authorization to Release Medical Information (HIPPA Form)
The Authorization to Release Medical Information allows you to decide which family members or friends Doctors Without Delay may communicate with about your health. Please give the completed form to the receptionist when you arrive.

Other Patient Forms

KSHSAA Sports Physical Form
The KSHSAA Pre-Participation Form is required for sports participation in Kansas schools. It must be completed after May 1 for the following school year.

KSHSAA Concussion Policy (2011)
This policy was established and published by KSHSAA in 2011 about concussions and student athletes. New changes in return-to-play rules include no return-to-play on the same day as an injury and recommendation of graduated participation upon return.

KSHSAA Concussion Consent Form (2011)
This consent form is required for sports participation beginning this year. It outlines the new policy and expectations for athletes.

Privacy Policy