NEW PATIENT FORMS

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IF YOU ARE UNCOMFORTABLE WITH THE ONLINE INTAKE FORM, PLEASE DON’T HESITATE TO CALL:  719-488-2292.  Marissa, TOMMIE OR SHELLY WILL BE HAPPY TO MAIL, OR EMAIL THE FORMS TO YOU.

I AM THE “PERSONAL REPRESENTATIVE” AND HAVE LEGAL AUTHORITY TO MAKE HEALTH CARE DECISIONS ABOUT THE FOLLOWING PATIENT: