Skip to content

For Appointments Call 833-350-1113
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
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Silver Linings Respite Care
    • Alamosa Rural Training Track
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Rural Recovery Network
  • For Patients
    • Coronavirus Updates
    • 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
  • Merger
  • 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
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Silver Linings Respite Care
    • Alamosa Rural Training Track
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Rural Recovery Network
  • For Patients
    • Coronavirus Updates
    • 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
  • Merger
  • Contact Us
  • Donate

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.

Google Translate
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
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Silver Linings Respite Care
    • Alamosa Rural Training Track
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Rural Recovery Network
  • For Patients
    • Coronavirus Updates
    • 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
  • Merger
  • 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
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Silver Linings Respite Care
    • Alamosa Rural Training Track
    • Vocational Training
    • Peer Support
    • Veteran Outreach
    • The Coffee Break Project
    • Community Trainings
    • Rural Recovery Network
  • For Patients
    • Coronavirus Updates
    • 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
  • Merger
  • 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 (2023)

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