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