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Mission and Forms

Our Mission

Patient Forms

New Patient Forms

Authorization to Release Information to Third Party

Release of Medical Records to Family Care Southwest

HIPAA

Pediatric New Patient Form
Have a child who is a new patient? Want to skip the 20 minutes of forms to fill out in the lobby on the child's first visit? Fill out this form to give us your child's medical history.

 

Notice of Privacy Protection

 

Medicare Participation in Comprehensive Primary Care (CPC) Initiative Letter This letter is explains the partnering of  Family Care Southwest with Medicare and other health insurance plans in the CPC Initiative.

CPC Initiative Patient Declines to Participate Letter

CORHIO - Colorado's information exchange Opt-out request form

 

Policies

No show Policy

Patient Financial Obligations 

Policy for Portal Use