DTC Family Health

PATIENT FORMS

This link includes:

Patient Demographics
Medical History
HIPAA/Office Policies

Click the link above to fill out the new patient forms and submit them before you schedule your visit.

Please call our office 2-3 business days after your paperwork is submitted, to schedule an appointment.
To schedule call: 303-771-3939

NEW PATIENT FORMS
CLICK HERE

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

ANXIETY SCREENING

DEPRESSION SCREENING

MEDICAL RELEASE FROM DTC FAMILY HEALTH

Online Form

PDF Downloadable Form

MEDICAL RELEASE TO DTC FAMILY HEALTH

Online Form

PDF Downloadable Form

MEDICARE WELLNESS EXAM & HEALTH RISK ASSESSMENT

PATIENT DEMOGRAPHICS (existing patients only)

Colorado COVID-19 Vaccine Screening and Administration Form