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Patient Forms

The patient forms below are provided to assist our staff in preparing you for your visit.

Should you require additional help, please feel free to contact us by phone: (580) 366-0179

Click Image to Open the PDF version of the Form. Once opened, you may save to your computer or print using the menu of your internet web browser or Adobe Reader. (to get Adobe Reader, click here)

Patient Health Questionnaire

Patient Health Questionnaire

Patient Information Form

Patient Information Form

Financial and Insurance Information

Financial and Insurance Information

Medical Records Release

Medical Records Release Form

Patient Drug List

Patient Drug List

our Patients are our #1 Priority

"Great Care"

"Dr. Worthen is an excellent doctor. He has cared for my husband since 2005, when he had kidney cancer. He has always been very professional and caring. And my husband is still cancer free. Great care."

Patient of Dr. Rodney Worthen • Enid, OK

"Good at Explaining Illness to Me Where I Could Understand"

"Found him to be good at explaining my illness to me where I could understand it. I was seen for kidney stones. He was able to get me right in and get me scheduled for surgery right away."

Patient of Dr. Jarrett D. Kruska • Enid, OK

"Always makes sure I understand everything"

"Been seeing Dr. Colvert for the last 5 years. Always good to explain each procedure I've had done and always makes sure I understand everything. Seems to be up on the latest procedure for my prostate problems"

Patient of Dr. James Colvert • Enid, OK