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Grand River Health in Rifle, Colorado
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        • Tom Barbata, PT, DPT, MHA
        • Bobbie Duncan, PTA
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        • Stacy Hardee, PT, DPT
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        • Phyllis Zilm, PT
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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

 

 

Grand River Clinics

Print and Fill out and bring with you to your first appointment.

English
  1. Clinic New Patient Forms English
  2. HIPPA
  3. Clinic Medical Records Release
  4. Gynecology New Patient Forms English
  5. Dr Krauth New Patient Forms English
  6. General Surgery New Patient Form
  7. Child History Questionnaire English
  8. Orthopaedic New Patient Forms
  9. ENT Intake form English
  10. Womens Health Questionnaire.pdf
  11. Consent to treat a Minor
  12. Mens Health Questionnaire
  13. CIIS questions
  14. Caputo Wound Care Intake Form
  15. Pediatric New Patient Form
  16. Sports Clearance Exam Form
  17. Facial Chemical Peels New Patient Forms
Spanish
  1. Clinic New Patient Forms Spanish
  2. HIPAA Spanish
  3. Clinic Med Red Release Spanish
  4. Gynecology New Patient Forms Spanish
  5. Dr Krauth New Patient Forms Spanish
  6. General Surgery New Patient Form Spanish
  7. Child History Questionaire Spanish
  8. Orthopedic New Patient Forms Spanish
  9. ENT-Intake form Spanish
  10. Womens Health Questionnaire Spanish
  11. Consent to Treat a Minor Spanish
  12. Mens Health Questionnaire Spanish
  13. CIIS Questions Spanish
  14. Caputo Wound Care Spanish 

Upcoming Grand River Events

  1. Rifle, Let’s Do Lunch!

    March 30 @ 10:45 am - 1:00 pm
  2. New Moms Support Group

    April 4 @ 10:00 am - 12:00 pm
  3. Grand River Gallop

    April 7 @ 7:00 am - 10:00 am
  4. 9Health Fair

    April 14 @ 7:00 am - 11:00 am
  5. Bariatric Support Group

    April 17 @ 5:30 pm - 7:00 pm

View All Events

Grand River News

  • Grand River staff members recognized at Service Excellence Conference in San Antonio, TX
  • Grand River Health Locks in 20 Year Interest Rate under 3.55% for Bond Issue to Build New Care Center and Expand Existing Hospital Capacity.
  • Cervical Cancer Awareness Month
  • HOW THE OPIOID EPIDEMIC HAS AFFECTED OUR COMMUNITY By Dr. Kevin Coleman, Chief Medical Officer, Grand River Health
  • Grand River Health’s Dr. Pamela McGrogan Among the First-who have Earned Board Certification in the Field of Lifestyle Medicine

Request for Qualifications & Proposal

click here to View RFQ

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