New Patients 

This page contains links to patient registration forms and useful information for our new families.

New Patient Website Packet

Packet of New Patient Information Forms that includes:

    • Patient / Family Information Form
      • Please use full legal names of children and include middle initials.
        • If your child has a preferred nickname, please include this as well.
      • For parents, please use full legal names, including middle initial.  This is especially true for policy holders, so that names match.
    • HIPAA / Insurance / Acknowledgement
    • Medical History
    • Financial Policy
    • Medical Records Transfer Request
      • Whenever possible, we ask that vaccine records be requested in advance of the first appointment and either faxed/emailed to our office, or brought to the first scheduled appointment.

Care Authorization Form

Complete this form to authorize additional family (step-parents/grandparents/other family) and/or friends to bring your child(ren) to appointments and make medical decisions on your behalf.

Form can be done for a specified period of time or ongoing until ended in writing.

Vaccine Policy

Our office is a vaccine-only clinic.  This means that children must be follow the AAP and state recommended vaccine guidelines in order to be seen in our office.

HIPAA Privacy Policy

 

Accepted Insurance Plans:

  • Aetna
  • Anthem/Blue Cross Blue Shield
  • Cigna – Most plans, but NOT the following:
    • Connect
    • Surefit
  • Colorado Children’s Health Plan / Colorado Access (CHP/COA)
  • Humana
  • Medicaid/Health First Colorado
  • Tricare
  • UMR
  • United Healthcare

If you are not a member of one of our contracted plans, we will be happy to see you under a fee-for service agreement.  Payment is expected to be paid at the time of service and you will receive a copy of the fee slip to submit to your plan.  We offer a discount for anyone who pays for their visit in full at the time of service.

It is your responsibility to understand your particular plan, as well as any health savings plans you may have in effect.  According to your insurance plan, you are responsible for any copays, deductibles, coinsurance or non-covered services.  Copays are due at the time of your visit.