Peak to Peak Family Practice Forms

New Patients

• New Patient Forms

If you are a new patient at Peak to Peak Family Practice please print off this document, complete the forms and bring it in with you on your first visit.

Other Individual Forms

• Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

• New Patient's Registration Form

If you are a new patient at Peak to Peak Family Practice, please fill out this form and bring it with you at your first visit.

• Individual Patient's Authorization Form

This form is used to authorize Peak to Peak Family Practice to contact the patient and/or insurance company with protected health information as needed.

• HIPAA Authorization for Release of Patient Information

This form is used to authorize Peak to Peak Family Practice to release protected health information to a designated third party at the patient's request.

• Medical History Information Form

This form is used to collect information on a patient's medical history.

• Hardship Advisory Form

This form confirms that the patient will pay his/her deductible.