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Clinic Forms

Our Main Clinic Forms

Our clinic at the UPI (University Physician's Inc.) building just north of the Anschutz Medical Campus is administered by Children's Hospital Colorado in conjunction with our doctors and researchers through the University of Colorado. There our patients are provided access to several forms about their various rights, responsibilities and notices outlining their health privacy and other information. Most of these forms our patients will see and be able to access during a visit to our clinic, however we are providing them here for the convenience of our patients should they need to access them and don't have them handy.

Outpatient Admission Agreement-

This is a consent form for treatment and is signed electronically each time a patient comes to our clinic for care.

Outpatient Financial Assistance Letter-

Information on the financial assistance programs available.

Notice of Privacy Practices-

This describes how medical information about patients may be used, disclosed and how you can access that information.

CareEverywhere/CORHIO Fact Sheet-

This is a brochure explaining the tools used to share and allow you access to your medical records.

Outpatient Rights and Responsibilities-

A brochure explaining the rights and responsibilities of patients and caregivers through Children's Hospital Colorado.

Advanced Directive-

A booklet designed for people 18 and older outlining their options in making healthcare decisions on their treatment.

Language ID card-

This is a card we have available in the event a patient or caregiver does not understand the language of our staff to assist them in gaining access to translation. 


Outreach Clinic Forms

Our Outreach Clinics are annual visits to treat patients we have in our region but distant from our clinic. These require specialized forms as they are administered by the University Hospital system. Please go to our Outreach Clinic page for more information.