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DTC Family Health

PATIENT FORMS

NEW PATIENTS

Please call our office to schedule an appointment.
To schedule call: 303-771-3939
NOTE: At this time we are not accepting new Medicaid or Health First Colorado patients.

FORMS FOR EXISTING PATIENTS ARE BELOW

If you are a new patient that has not been scheduled yet, please ONLY fill out the new patient forms above.

ACKNOWLEDGEMENT FORM

- OFFICE AND FINANCIAL POLICIES

- HIPAA NOTICE OF PRIVACY PRACTICES

CHRONIC CARE MANAGEMENT AGREEMENT

CONTROLLED SUBSTANCE AGREEMENT

COUNSELING DISCLOSURE STATEMENT

RECENT MEDICAL HISTORY FORM

MAIN MEDICAL HISTORY FORM

MEDICARE SHARED SAVINGS PROGRAM ACCOUNTABLE CARE ORGANIZATIONS

ANXIETY SCREENING

DEPRESSION SCREENING

MEDICAL RELEASE FROM DTC FAMILY HEALTH

PDF Downloadable Form

MEDICAL RELEASE TO DTC FAMILY HEALTH

PDF Downloadable Form

MEDICARE WELLNESS EXAM & HEALTH RISK ASSESSMENT

PATIENT DEMOGRAPHICS (existing patients only)

Colorado COVID-19 Vaccine Screening and Administration Form

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