Skip to content

Valley-Wide has transitioned to a new patient portal called InteliChart. This new portal will make it easier than ever to access your medical records and manage your health!

For Appointments Call 833-350-1113
enes
Patient Portal
Pay My Bill
Schedule an Appointment
Search
Close this search box.
  • About Us
  • Services
    • Family Medicine Services
    • Behavioral Health Services
    • Crisis Services
    • Virtual Visits & Telehealth
    • Family Dental Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Patient Navigation
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Residency Programs
    • Silver Linings Respite Care
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Patient Family Advisory Council (PFAC)
    • Rural Recovery Network
  • For Patients
    • Newsletter Sign Up
    • Patient Forms
    • Patient FAQ’s
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
  • Donate
Menu
  • About Us
  • Services
    • Family Medicine Services
    • Behavioral Health Services
    • Crisis Services
    • Virtual Visits & Telehealth
    • Family Dental Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Patient Navigation
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Residency Programs
    • Silver Linings Respite Care
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Patient Family Advisory Council (PFAC)
    • Rural Recovery Network
  • For Patients
    • Newsletter Sign Up
    • Patient Forms
    • Patient FAQ’s
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
  • Donate
For Appointments Call 833-350-1113
Pay My Bill
Patient Portal
Schedule an Appointment
enes
  • About Us
  • Services
    • Family Medicine Services
    • Behavioral Health Services
    • Crisis Services
    • Virtual Visits & Telehealth
    • Family Dental Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Patient Navigation
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Residency Programs
    • Silver Linings Respite Care
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Patient Family Advisory Council (PFAC)
    • Rural Recovery Network
  • For Patients
    • Newsletter Sign Up
    • Patient Forms
    • Patient FAQ’s
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
  • Donate
Menu
  • About Us
  • Services
    • Family Medicine Services
    • Behavioral Health Services
    • Crisis Services
    • Virtual Visits & Telehealth
    • Family Dental Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Patient Navigation
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Residency Programs
    • Silver Linings Respite Care
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Patient Family Advisory Council (PFAC)
    • Rural Recovery Network
  • For Patients
    • Newsletter Sign Up
    • Patient Forms
    • Patient FAQ’s
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
  • Donate

Forms for Behavioral Health Patients

If you have an in-person visit, please print and fill out all forms and bring them with you to your appointment. All forms can be handed to the front desk during check-in.

English

Patient Information Form
Consent for Treatment
Notice of Privacy Practices
Mandatory Disclosure Integrated Behavioral Health
Patient Rights and Responsibilities
BH Release of Information
BH Protected Health Information Request
Patient Information Brochure
BH Acknowledgement of Treatment Goals and Service Planning
Advance Beneficiary Notice
Authorization for Designated Client Representative
Patient Decision Against Medical Advice

Spanish

Informacion del Paciente
Consentimiento para Tratamiento
Aviso de Practicas de Privacidad
Servicios Integrado de Salud Conductual
Derechos y Responsabilidades de los Pacientes
Autorizacion de Salud Conductual para Divulgar Intercambiar Informacion de Salud Protegida
Solicitud de Information Medica Protegida de Salud Conductual
Informacion Para el Paciente
Reconocimiento de los Objetivos del Tratamiento y Planificacion de Servicios
Aviso Anticipado de no Cobertura al Beneficiario
Decision del Paciente Contra el Consejo Medico

Additional Forms for Patient Under 18 or Adolescents

Adolescent Visit Consent
Unaccompanied Minor
Partial Parental Delegation Authority
Financially Independent Minor
Consentimiento para una Visita de Tratamiento de un Adolecente
Menor No Acompanado
Delegacion de Autoridad Parcial de los Padres para el Tratamiento
Menor de edad Financieramente Independiente
Google Translate
enes
Patient Portal
Pay My Bill
Contact Us
  • About Us
  • Services
    • Family Medicine Services
    • Behavioral Health Services
    • Crisis Services
    • Virtual Visits & Telehealth
    • Family Dental Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Patient Navigation
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Residency Programs
    • Silver Linings Respite Care
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Patient Family Advisory Council (PFAC)
    • Rural Recovery Network
  • For Patients
    • Newsletter Sign Up
    • Patient Forms
    • Patient FAQ’s
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
  • Donate
  • About Us
  • Services
    • Family Medicine Services
    • Behavioral Health Services
    • Crisis Services
    • Virtual Visits & Telehealth
    • Family Dental Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Patient Navigation
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Residency Programs
    • Silver Linings Respite Care
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Patient Family Advisory Council (PFAC)
    • Rural Recovery Network
  • For Patients
    • Newsletter Sign Up
    • Patient Forms
    • Patient FAQ’s
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
  • Donate

Main Office: 128 Market Street, Alamosa, CO 81101 | 719-587-1001
© Valley-Wide Heath Systems, Inc. | Sitemap | Privacy Policy | Built by Infront Webworks

Linkedin-in Twitter Facebook-f Instagram

Recognized by the American Heart Association (2024)

Recognized by the American Heart Association: Target BP (2024)

Accredited/Certified by
HRSA Health Center Program Operational Site Visit

HRSA Recognition: Addressing Social Risk Factors (2023)

HRSA Recognition: Advancing HIT for Quality (2023)

HRSA Recognition: Access Enhancer (2023)

HRSA Recognition: Health Disparities Reducer (2023)

AAAHC Accreditation

HRSA Recognition: Patient Centered Medical Home

FTCA Seal 5.3.22