Patient Intake Form
Patient Intake Form
Please carefully fill out our secure Patient Intake Form as thoroughly and completely as possible, digitally sign it and submit it prior to your initial visit.
After submitting your form, please follow the prompt in the follow-up email to verify your email address.
Use this link if you would prefer to download the form, fill it out, print and sign it and bring it into our office: Patient Intake Form
After submitting your form, please follow the prompt in the follow-up email to verify your email address.
Use this link if you would prefer to download the form, fill it out, print and sign it and bring it into our office: Patient Intake Form
TO START, PLEASE SCROLL TO THE BOTTOM AND CLICK THE CONTINUE BUTTON.
Please set aside about 10–15 minutes to complete your intake paperwork in one sitting. For the most reliable experience — especially on a phone or tablet — the secure form opens in its own tab.
Start the Patient Intake Form →
The form is hosted securely by Adobe Acrobat Sign. If a button does not open, copy this link into your browser:
https://na4.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhCi8AOwc0kZ_G5pRAMWm8c3-lxkCyhBC4OfOl3dy2fzluw4R-Xi-Nm5OSyXo8EwbR0*&hosted=false
Contact Us
702 West Drake Road, Bldg E, Ste A
Fort Collins, Colorado 80526
u200b
Phone: (970) 416-8342
Fax: (970) 416-8344
Email: [email protected]