501 Airport Road, Rifle, Colorado 81650 | 970-625-1510 | Contact Information Facebook Twitter YouTube Patient Portal >

All forms are in Downloadable Printable PDF format.

Grand River Health Medical Records (Health Information Management)

Release of Medical Information

Fax  to 970.625.2752

Phone: 970.625.6412

Please print and fill out to bring with you to your next appointment

English

  1. Clinic New Patient Forms English
  2. HIPPA
  3. Clinic Medical Records Release
  4. Dr Krauth New Patient Forms English
  5. General Surgery New Patient Form
  6. Child History Questionnaire English
  7. Orthopaedic New Patient Forms
  8. ENT Intake form English
  9. Womens Health Questionnaire.pdf
  10. Consent to treat a Minor
  11. Mens Health Questionnaire
  12. CIIS questions
  13. Caputo Wound Care Intake Form
  14. Podiatric New Patient Form
  15. Sports Clearance Exam Form
 Spanish

  1. Formularios para pacientes nuevos en la clínica
  2. HIPAA
  3. Divulgación de expdientes médicos de la clínica
  4. Formularios para pacientes nuevos del Dr Krauth
  5. Pacientes nuevos de cirugía general
  6. Cuestionario del historial del niños
  7. Formularios para pacientes nuevos de ortopedia
  8. Formulario de ORL
  9. Cuestionario de salud femenina
  10. Consentimiento para tratamiento de menores
  11. Cuestionario de salud masculina
  12. Preguntas del SIIC
  13. Tratamiento de heridas del Dr Caputo

Events Calendar

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Tue 11

Blood Drive

June 11 @ 10:00 am - 1:00 pm
Wed 12

Baby and Me

June 12 @ 10:00 am - 12:00 pm
Wed 12

Ground Breaking for the Hospital Expansion

June 12 @ 12:00 pm - 12:30 pm
Wed 19

Baby and Me

June 19 @ 10:00 am - 12:00 pm
Wed 19

Walk With A Doc

June 19 @ 5:50 pm - 7:00 pm

Grand River News

501 Airport Road Rifle, Colorado 81650 | 970.625.1510 | Follow My Health Patient Portal | Privacy Information | Información de privacidad