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

Our Forms and Policies

New Patients:

New Patient Welcome Letter.pdf
Adobe Acrobat document [950.6 KB]
New Patient Information.pdf
Adobe Acrobat document [533.9 KB]

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:

Financial Policies.pdf
Adobe Acrobat document [867.7 KB]
No Show Policy.pdf
Adobe Acrobat document [605.3 KB]
Telephone Call Policy.pdf
Adobe Acrobat document [682.6 KB]

Forms:

Auto Accident Form.pdf
Adobe Acrobat document [559.1 KB]
HIPPA Signature Page.pdf
Adobe Acrobat document [82.2 KB]
Dr Rivera's Physical Form.pdf
Adobe Acrobat document [660.9 KB]

Medicare Charges:

Understanding Medicare Charges.pdf
Adobe Acrobat document [710.5 KB]

Tips:

Tips for Cold and Flu.pdf
Adobe Acrobat document [987.8 KB]

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 Carney

 

Regular Office Hours:

Monday - Friday: 8am-5pm

 

For life threatening emergencies; CALL 911.

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