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

Patient Forms

Please arrive to the clinic at least 30 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.
New Cough Center Patient Packet
Information and forms for new patients at our Cough Center.
New Asthma Center Patient Packet
Information and forms for New patients at our Asthma Center.
Insurance & Yearly Update Form
Must be filled out for change of insurance and yearly updates.
Medical History Release Form
Authorization to Receive or Release Medical Records.
New Allergy Shot Patient Forms
Information and forms for allergy shot patients.
In-Office Extract Reorder Form
Allergy extract (antigen) reorder form for current patients.
Mail out Extract Reorder Form
Mailout allergy extract (antigen) reorder form for current patients.