Important Forms

Click the link below to download PDF

• Welcome to Winfield Surgery: clinic info

• New Patient Form (PDF)

• New Patient Medical History Form (PDF)

• Medical Request Form
  Use this form to transfer your records from another physician or group.

• HIPPA Notice of Privacy Practices

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Financial Assistance

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• Financial Assistance Summary and Application

• Financial Assistance Policy

• Resumen de Asistencia Financiera

• Non-Covered Provider List

PATIENTS: If you made a credit card payment through the website during the month of April 2018, please contact our WSS billing office at 620-221-4000.

Resources/Patient Education

• William Newton Hospital

• Care for your Incision (PDF)

• Gallbladder Surgery (PDF)

• Colonoscopy Prep (PDF)

• Hernia Surgery (PDF)

• Pre-Op Instructions (PDF)