A NOTE TO NEW PATIENTS
Welcome! Prior to your first visit, please print and complete a disclosure statement in addition to the appropriate intake form (newborn, pediatric, or adult). If you would like the doctors at Mountain River Clinic to have access to previous medical records (laboratory & imaging results, chart notes), please also complete a release of records form and bring this to your first visit. If you do not have access to a printer at home, please arrive 15-20 minutes prior to the time of your scheduled appointment to fill out the necessary documentation. Thank you and we look forward to supporting you and your health goals!
NEW PATIENT PAPERWORK
Disclosure Statement (PDF) Privacy and regulatory information that needs to be signed before your visit
Adult Intake (PDF) Ages 18+ (click button below)
Pediatric Intake (PDF) Ages 2 to 17 years
Release of Records (PDF) Request previous medical records
ADDITIONAL QUESTIONNAIRES
Diet Diary (PDF) It is often helpful for us to see what your typical diet is like
Welcome! Prior to your first visit, please print and complete a disclosure statement in addition to the appropriate intake form (newborn, pediatric, or adult). If you would like the doctors at Mountain River Clinic to have access to previous medical records (laboratory & imaging results, chart notes), please also complete a release of records form and bring this to your first visit. If you do not have access to a printer at home, please arrive 15-20 minutes prior to the time of your scheduled appointment to fill out the necessary documentation. Thank you and we look forward to supporting you and your health goals!
NEW PATIENT PAPERWORK
Disclosure Statement (PDF) Privacy and regulatory information that needs to be signed before your visit
Adult Intake (PDF) Ages 18+ (click button below)
Pediatric Intake (PDF) Ages 2 to 17 years
Release of Records (PDF) Request previous medical records
ADDITIONAL QUESTIONNAIRES
Diet Diary (PDF) It is often helpful for us to see what your typical diet is like
Contact
507C Main Street / PO Box 4236
Frisco, CO 80443
Phone: 970.668.1300
Fax: 970.668.1301
Note to patients: Email is designed for non-urgent & brief questions or points of clarification on previous appointments. It is not a HIPAA-compliant form of communication. If you have detailed concerns or questions, an office visit is the most appropriate place to provide clinical care.
[email protected] (Dr. Nearpass and Dr. Pollack)
[email protected] (to reach Dr. Lisa)
507C Main Street / PO Box 4236
Frisco, CO 80443
Phone: 970.668.1300
Fax: 970.668.1301
Note to patients: Email is designed for non-urgent & brief questions or points of clarification on previous appointments. It is not a HIPAA-compliant form of communication. If you have detailed concerns or questions, an office visit is the most appropriate place to provide clinical care.
[email protected] (Dr. Nearpass and Dr. Pollack)
[email protected] (to reach Dr. Lisa)
