Records Release to send records from The Family Practice
Records Release to receive records at The Family Practice
Print and fill out the appropriate request. If you are requesting records from us, fax it to our office at (719) 266-5245 or send it to the office from where you are requesting records.
If you require us to fill out paperwork for FMLA or disability,
please print and fill out this page and drop it off with the paperwork
(failure to have this with your paperwork will result in a delay of us being able to fill it out)
Print and fill out this paper out if we are billing an MVA insurance for any visits-
failure to do so will cause any visits to be billed to the patient for payment.
As a patient-centered medical home, we are to encourage and support our patients to play an active role in their own health. We ask you to print up this page and fill it out before your next appointment. Bring it with you to your appointment and give it to the provider.