Before your first visit to LPFP you will need to download, print, and fill out the forms below. You may bring them in with you to your appointment, or to expedite the process you may fax them to our secure line at 303.772.8207 or mail them to the office.
General office forms:
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- Registration form: Download and print
- Financial Policy
- Notice of Privacy Practice (You may review or print for your records)
- Authorization to Release Medical Information
- Acknowledgement of Privacy Practices and Signature Verification Form
- Physical exam charges
- Notice of Non-Discrimination (You may review or print for your records)
- Telemedicine Consent
- Missed Appointment Policy
You may review or print for your records.
Health history and lifestyle forms:
- Adult Health History
- Lifestyle (all new physicals ages 18 and over)
- Adolescent Health History and Lifestyle (ages 12-17)
- Pediatric Health History (newborn to age 11)
- Sports physical for school and college
We would like to have a copy of your previous medical records. You may fill out the request below and either bring your records, have your previous doctor send them, or have our office acquire them.
Also, please bring your current insurance card and photo ID to your visit.
Please complete the following forms and bring them to your
Annual Physical Exam:
- Medical history update – female (18 years and over) Download or Online
- Medical history update – male (18 years and over) Download or Online
- Adolescent update (ages 12-17)
- Child update (ages 6-11)
In addition to the forms below, please complete all General Office forms in the Patients new to LPFP section above.
In addition to the forms below, please complete all General Office forms in the Patients new to LPFP section above.
- DPC Agreement Forms Access
Our DPC agreements are password protected. Please contact our office for the password to access the agreements. You can send an email addressed to DPC, use our online form, or call our membership team (Vickie, Karen, and Tanya) at 303-772-5578.
