One Mercado Street, Suite 200 Durango, CO 81301
Medical Records Forms
Medical Records Release Form - Authorization to Use or Disclose Protected Health Information (1 page)
Patient Pre-Registration Forms
If you have an appointment in our office and would like to complete your registration process, please print the following form(s). These can be mailed to us if time allows, or you may bring them with you at the time of your appointment.
If you are a new patient please complete both a registration and health history form.
Health History form for all physicians
We would also appreciate your time to complete one of the following forms, which will tell us about your injury or symptom:
Back or neck injury or symptom (2 pages)
Shoulder injury or symptom (2 pages)
Knee injury or symptom (2 pages)
Other injury or symptom (hand, wrist, arm, elbow, hip, leg) (1 page)
If time allows, mail the completed forms to the following address:
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