Your First Visit: 

We consider it a privilege to work with you and we are delighted to have you as a patient!

We hope that ours will be a satisfying relationship based on mutual respect.   We aspire to treat all of our patients with the same consideration that we desire for ourselves and our families.

Following are the forms that need to be filled out prior to your first visit.

If you like, you may come in early to your appointment and fill out the forms in our office. 

You may find it more convenient, however, to print out the forms at home, fill them out, and bring them with you. Alternatively, if you use Word forms, you can type out your information, save it for future visits, and update it if necessary.

Please print these forms single sided!  - thanks.

forward your records to us: Forward your MEDICAL RECORDS  to us form

pdf forms
History form *first visit only
Release of information form
Personal information
Guarantee of payment consent form
release Release of information form
release Medication dispensing program
all forms as one pdf file - here

Click to download pdf versions of the patient history, privacy, personal information or medical records release forms. To read and print pdf files you need  a copy of acrobat reader, its free!

Disclosure of protected health information : Access to your health information is protected by law. For us to receive your information from another Doctor or health care provider we need your written permission.
 
Bring your insurance card to every appointment. Think of your insurance card as a credit card. Even if you were just in a day ago, WE STILL NEED TO SEE YOUR INSURANCE CARD AT EVERY VISIT.
If you have a "co-pay", you are expected to pay it before you are seen.  We are happy to accept your Mastercard or VISA card. If you cannot pay your co-pay and must be seen, we will bill you. However, there is an additional billing charge added for this service.
If your insurance has a "deductible" or "coinsurance" or originates outside of Colorado, you will be asked to provide a credit card for the balance.  You will be informed if the balance charged to your credit card is more than $200.  A credit card receipt will be sent to you for all charges. 
If you would like us to have records from any other physician(s), please print out the medical records request form, sign and date it, and send it to your former physician or the institutions from which you would like us to have and review your medical records.
last update: 29-Apr-2012