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. 

​

​

Sports Physical Forms

 

Colorado High School Activities Association Sports Physical Form

     - used at Bayfield High School

DHS Sports Physical Form

Escalante Middle School Physical Form

Miller Middle School Physical Form

YAFL Form

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