Phone 719-955-6000
Toll-free866-615-3885
Fax 719-955-9595

Patient Forms

Please arrive to the clinic at least 15 minutes prior to your scheduled appointment. This is extremely important as you will need to sign additional forms and we will need to make a copy of your insurance card.

Please print the following pertinent forms, fill them out and return them to our clinic at your appointment or you may also fax them to us at 719-955-9595.

Help with On-Line Forms, contact our web site help by clicking here.

New Patient Packet
Information for new patients about our office and what you can expect.
Download New Patient Packet
New Cough Center Patient Packet
Information and forms for new patients at our Cough Center.
Download New Cough Center Patient Packet
Cough Center Follow-up Form
Cough center patients should fill out these forms for follow up visits.
Download Cough Center Follow-up Form
New Asthma Center Patient Packet
Information and forms for New patients at our Asthma Center.
Download New Asthma Center Patient Packet
Allergy Shot Patient Form
Information and forms for allergy shot patients.
Download Allergy Shot Patient Form
Insurance Change Form
Must be filled out for change of insurance.
Download Insurance Change Form
Yearly Update Form
Once a year for all patients.
Download Yearly Update Form
Medical History Release Form
Authorization to Receive or Release Medical Records.
Download Medical History Release Form