Specialty Outreach Clinics For Children
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CU Outreach Forms

New Patient Forms

The following forms are for patients of CU Specialty Outreach Clinics for Children.  Before completing these, please be sure to schedule an appointment. 

New Patient Packets

Once you have an appointment, please print and fill out the new patient packet before you come to the office. This will help you be seen faster. If you don't have access to a printer we will provide these forms when you arrive.


Privacy Practices

The Notice of Privacy Practices document describes the University of Colorado School of Medicine and University Physicians, Inc.’s practices, uses and disclosures of your medical information.


Additional Forms

  • Advance Beneficiary Notice of Noncoverage (ABN) - English Download PDF
  • Notificación Previa de No-Cobertura al Beneficiario (ABN) - Spanish Descargar PDF
  • Notice of Privacy Practice Acknowledgement Download PDF
  • Acuso de Recibo de Aviso Conjunto de Practicas de Privacidad Descargar PDF
Contact Us
In An Emergency: Please Dial 911

University of Colorado Medicine (CU Medicine)
http://www.CUmedicine.us/contact-us
Refer a Patient: 720-848-2828
Billing Questions: 303-493-7000

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