Phone: (720) 730-6670 Fax: (928) 358-4532

I request that several forms be reviewed and completed by the time of your first visit. 

Forms are also available through the Patient Portal, and can be electronically signed. 

 

*If you can't or prefer not to use the portal, please complete and print/sign the underlined intake forms below and bring completed to the first visit: 

ADULTS

CHILDREN/ADOLESCENTS

Privacy form

Consent for Telemedicine

Release of Information Form

Practice Policies

Surprise Billing Form

OTHERS:

Vanderbilt Assessment Forms (for ADHD)

Adult ADHD Self-Rating Scale

Depression Rating Scale

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