FORMS & POLICIES

FORMULARIOS Y POLÍTICAS

QUÉ LLEVAR A LA PRIMERA CITA

PATIENT REGISTRATION FORM- english or spanish
- ADD A MINOR PATIENT REGISTRATION FORM english or spanish (to add any minors you are also registering) OR, if you are only registering minors you are the parent/guardian of and not yourself:
- MINORS ONLY PATIENT REGISTRATION FORM – english or spanish
HEALTH INFORMATION RELEASE FORM- english or spanish
BEHAVIORAL HEALTH CONSENT FORM - english or spanish
ITEMS LISTED IN THE ENROLLMENT VISIT checklist

IF you are unable to bring pay-stubs as proof of income, please fill out the:

EMPLOYEE INCOME VERIFICATION FORM (your employer must fill out)

SELF-EMPLOYMENT LEDGER (if you are self-employed) english or spanish

IF you are interested in a health insurance plan through Connect for Health Colorado and you (or your spouse) are offered employer health insurance, please fill out this EMPLOYEE COVERAGE TOOL.

MEDICARE ANNUAL WELLNESS VISIT- if you are receiving a Medicare Annual Wellness Visit, please print out and fill out this form and bring to your visit. english or spanish

TRATAMIENTO DE UN MENOR

All children under the age of 18 must be accompanied by a parent or a legal guardian when visiting Salud for the first time and once per year thereafter. We understand that parents or legal guardians may not always be available to bring their children in and may wish to authorize a child to attend a visit alone or with another adult.

Salud permite que los niños mayores de 13 años asistan solos a las visitas. El padre, madre o tutor legal puede autorizarlo antes de la visita cumplimentando los formularios de autorización que figuran a continuación.

AUTHORIZATION FOR A MINOR TO BE ACCOMPANIED BY SOMEONE OTHER THAN A PARENT/GUARDIAN - english or spanish
AUTHORIZATION FOR TREATMENT OF A MINOR WITHOUT A PARENT/GUARDIAN PRESENT - english or spanish

SALUD FORMAS GENERALES Y POLÍTICAS

CONSENT FOR TREATMENT- late & missed appointment policy and the financial policy, english and spanish

SALUD IS YOUR MEDICAL HOME- describes how Salud serves as your Medical Home, english and spanish

PATIENT RIGHTS & RESPONSIBILITIES- describes the rights and responsibilities of a Salud patient, english and spanish

IMMUNIZATION INFORMATION OPT OUT- to remove your/your child's immunization information