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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.
- New Patient Packet - English Download PDF
- New Patient Packet - Spanish Descargar PDF
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.
- Notice of Privacy Practices - English Download PDF
- Notificacion de Practicas Privadas - Spanish Descargar PDF
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
- Consent To Treat - English Download PDF
- Consentimiento Para Recibir Tratamiento - Spanish Descargar PDF
- Patient Rights and Responsibilities - English Download PDF
- Patient Rights and Responsibilities - Spanish Descargar PDF
- Registration Information Request Download PDF
- Registration Information Request - Spanish Descargar PDF
- Self Pay Agreement Download PDF
- UPI Insurance Waiver Download PDF
