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Pediatric Partners of the Southwest
Medical Records Release Form

 

Click here to open the form to request records from your child's previous medical provider(s). This can be used to request records to be sent to us (for new patients), or to have us send records to your new doctor. Please fill out one for each prior provider, and email back to us at MedicalRecords@ppswdurango.com

          Click here for the Spanish form

New Patient Packet

 

Click here to print the 3-page New Patient Information Pack in English.

Click here for the 3-page New Patient Information Pack in Spanish

and here to print the Medical History Form

Please fill out the forms and bring with you to your first appointment. 

Alex Shackel
 
Tele-Health Forms

 

Tele-Health Technology Requirements

Consent for Tele-Health Service

 
Young Adult Forms

           

          Consent to Share Medical Information for Patients over 18

HIPAA Privacy Practices

          Click here for our HIPAA Notice of Privacy Practices form