The Family Clinic of Fort Collins
The Family Clinic of Fort Collins

Our Forms and Policies

New Patients:

New Patient Information Pg. 1
New Patient Information Page.jpg
JPG image [1.2 MB]
New Patient Information Pg. 2
New Patient Information Page 2.jpg
JPG image [1.1 MB]
New Patient Welcome Letter
New Patient Welcome Letter.jpg
JPG image [1.3 MB]

Records:

Records Release FROM Family Clinic
CCF01252018.pdf
Adobe Acrobat document [788.1 KB]
Records Release TO Family Clinic
CCF01252018_0001.pdf
Adobe Acrobat document [805.2 KB]

Policies:

No Show Policy
No Show Policy.jpg
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Patient Finances Policy
CCF01102018.pdf
Adobe Acrobat document [826.3 KB]
Telephone Call Policy
Telephone Call Policy.jpg
JPG image [964.4 KB]

Forms:

Auto Accident Form
Auto Accident Form.jpg
JPG image [743.1 KB]
Hipaa Signature Form
New Patient Hipaa Signature Page.jpg
JPG image [888.1 KB]
***Rivera Physical Form Pg. 1
Rivera physical form pg 1.jpg
JPG image [1.4 MB]
***Rivera Physical Form Pg. 2
Rivera physical form pg 2.jpg
JPG image [1.3 MB]

Medicare Charges:

Understanding Medicare Charges
Understanding Medicare Charges.jpg
JPG image [999.9 KB]

Tips:

Tips To Prevent Cold and Flu
Tips to prevent Cold and Flu.jpg
JPG image [1.3 MB]

Contact Us

The Family Clinic of Fort Collins:

1212 E Elizabeth St

Fort Collins, CO 80524

See map...

 

Office Phone:

970-482-2791

 

Fax:

970-495-9843

 

E-Mail:

joely@familyclinicfc.com

 

Office Manager:

Joely

 

Regular Office Hours:

Monday - Friday: 8am-5pm

 

For life threatening emergencies; CALL 911.

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© Family Clinic of Fort Collins