Download and fill out these forms, then upload them to your provider’s office using Medical File Share.
New patients must submit a photo or copy of driver’s license and insurance card, front & back, when submitting a New Patient Request form.
New Patient Request Form
Western Colorado Pediatrics: New Patient Request Form
Western Colorado Pediatrics: Social Family History Intake
New Insurance Information
Records Release Authorization (ROI)
Parental Consent for Adult Child
Western Colorado Pediatrics: Clinic Overview
Separated/Divorced Families Guide- English
Minor Proxy Registration Instructions: Patient Portal
Minor Proxy Release Form: Patient Portal
Adult Proxy Registration Instructions: Patient Portal
Adult Proxy Release Form: Patient Portal
Western Colorado Pediatrics: Clinic Overview – Spanish
Separated/Divorced Families Guide- Spanish
Minor Proxy Registration Instructions: Patient Portal – Spanish
Adult Proxy Release Form: Patient Portal – Spanish
Minor Proxy Release Form: Patient Portal – Spanish