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Patient Forms

New Patient Forms

English
Patient Information Form
VWHS Health History Form
Notice of Privacy Practices
Release of Information
Partial Parental Delegation of Authority for Treatment
Spanish
Formas de informacion al Paciente
Forma de la Historia de Salud
Aviso de Practicas de Privacidad
Autorizacion para Divulgar y/o Intercambio de Expedientes Mèdicos
Formulario de Delegación de Autoridad Parcial de los Padres para el Tratamiento

Other Downloadable Forms

English
Nurse Family Partnership Referral Form
Complete Transfer of Care Authorization
Unaccompanied Minor Form
Advance Directive for Mental Health
Colorado Medical Orders for Scope of Treatment (MOST) form
Spanish
Formulario Para Un Menor No Acompanado
Forms for School Based Health Patients
Unite Colorado Self Referral Form
Google Translate
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Main Office: 128 Market Street, Alamosa, CO 81101 | 719-587-1001
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Recognized by the American Heart Association (2020)

Accredited/Certified by
HRSA Health Center Program Operational Site Visit

HRSA Recognition: Advancing HIT for Quality

HRSA Recognition: COVID-19 Data Reporter

AAAHC Accreditation

HRSA Recognition: Patient Centered Medical Home

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