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- About
- [Naturopathic Medicine](https://www.mountainriverclinic.com/about/naturopathic-medicine)
- [Mountain-River Naturopathic Clinic](https://www.mountainriverclinic.com/about/about-mountain-river-naturopathic-clinic)
- [Dr. Kim Nearpass, ND](https://www.mountainriverclinic.com/about/dr-kim-nearpass-naturopathic-doctor)
- [Dr. Justin Pollack, ND](https://www.mountainriverclinic.com/about/dr-justin-pollack-naturopathic-doctor)
- [Laura Eickhoff, LPN](https://www.mountainriverclinic.com/about/laura-eickhoff-licensed-practical-nurse)
- How We Help
- [ Common Health Conditions Treated](https://www.mountainriverclinic.com/how-we-help/common-health-conditions-treated)
- [How We Diagnose](https://www.mountainriverclinic.com/how-we-help/how-we-diagnose)
- [Therapies](https://www.mountainriverclinic.com/how-we-help/therapies)
- [Arvigo Technique of Maya Abdominal Therapy™ (ATMAT)](https://www.mountainriverclinic.com/how-we-help/arvigo-technique-of-maya-abdominal-therapy-atmat)
- [Theramedix BioSET](https://www.mountainriverclinic.com/how-we-help/theramedix-bioset)
- For Patients
- [Forms](https://www.mountainriverclinic.com/for-patients/forms)
- [Herbs & Supplements](https://www.mountainriverclinic.com/for-patients/herbs-supplements)
- [Articles/Resources](https://www.mountainriverclinic.com/for-patients/articles-resources)
- [Testimonials](https://www.mountainriverclinic.com/testimonials)
- [FAQ's](https://www.mountainriverclinic.com/faqs)
- [Contact Us](https://www.mountainriverclinic.com/contact-mountain-river-clinic)
- [Schedule Appointment: 970-668-1300](tel:1-970-668-1300)
- [Schedule Appointment: 970-668-1300](tel:1-970-668-1300)
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# For Patients
# Forms
**A NOTE TO NEW PATIENTS**
Welcome! Prior to your first visit, please print and complete a disclosure form in addition to the appropriate intake form (Pediatric or Adult). Ideally, please print or email your completed paperwork prior to your initial visit. You may also arrive 15 minutes before your scheduled appointment to fill out the necessary documentation, as long as your appointment is no earlier than 10:15 am, since our front desk does not open until 10:00 am. Thank you and we look forward to supporting you and your health goals!
[### Disclosure Statement (PDF)
Privacy and regulatory information that needs to be signed before your visit
Download ↓
](https://www.mountainriverclinic.com/images/forms/disclosure_statement_updated-mountain-river.pdf)
[### Adult Intake (PDF)
Ages 18+
Download ↓
](https://www.mountainriverclinic.com/images/forms/adult-intake-2024-mountain-river.pdf)
[### Pediatric Intake (PDF)
Ages 2 to 17 years
Download ↓
](https://www.mountainriverclinic.com/images/forms/pediatric_patient_profile__2020_mountain-river.pdf)
[### Diet Diary (PDF)
It is often helpful for us to see what your typical diet is like
Download ↓
](https://www.mountainriverclinic.com/images/forms/diet_diary-mountain-river.pdf)
## Schedule your health journey appointment: [970-668-1300](tel:1-970-668-1300)
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- [](https://www.instagram.com/mountainrivernaturopathic/)
### Phone/Fax
T: [970-668-1300](tel:1-970-668-1300)
F: 970-668-1301
### Clinic address
507C E Main Street
Frisco, CO 80443
### Mailing address
PO Box 4236
Frisco, CO 80443
[ Email Us ](https://www.mountainriverclinic.com/contact-mountain-river-clinic "Email Us")
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## Serving
Summit County, Frisco, Silverthorne, Dillon, Breckenridge, Blue River, Copper Mountain, Keystone, Heeney, Montezuma, Grand County, Kremmling, Granby, Hot Sulphur Springs, Winter Park, Parshall, Fraser, Grand Lake, Tabernash, Lake County, Leadville, Twin Lakes, Park County, Alma, Fairplay, Hartsel, Clear Creek County, Silver Plume, Georgetown, Idaho Springs, Saint Mary's, Downieville, Lawson, Dumont, Chaffee County, Buena Vista / BV, Nathrop, Johnson Village, Poncha Springs, Salida, Granite, Twin Lakes, Eagle County, Vail, Eagle-Vail, Avon, Beaver Creek Minturn, Eagle, Edwards, and Gypsum
**Web Site Disclosure**
The information on this website is for educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for your specific medical needs.
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