Information About COVID-19 • Information About Monkeypox

For Appointments Call 833-350-1113
Patient Portal
Pay My Bill
Schedule an Appointment

School-Based Health Forms

Patient Info Brochure English and Spanish

Forms in English

Patient Information Form
Health History Form
Adolescent Visit Consent Form
Behavioral Health/Solvista Consent Form for Children Over 12
Hygiene Services Consent Form
Parental Delegation Form
Unaccompanied Minor Form
Notice of Privacy Practices

Forms in Spanish

Formulario de Información del Paciente
Cuestionario Historia de Salud
Consentimiento para una Visita de Tratamiento de un Adolecente
Delegación de Autoridad Parcial de los Padres para el Tratamiento
Formulario Para Un Menor No Acompañado
Aviso de Practicas de Privacidad

Please submit forms to SBHC@valley-widehealth.org If you need assistance, please contact our front desk staff at 719-204-7410.

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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

AAAHC Accreditation

HRSA Recognition: Advancing HIT for Quality

HRSA Recognition: COVID-19 Data Reporter

HRSA Recognition: Patient Centered Medical Home

FTCA Seal 5.3.22