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  • Home
  • Your Hospital District
    • Volunteer Services
      • Grand River Hospital District Volunteer Association (GRHDVA)
      • Meals on Wheels
        • March for Meals
        • Blizzard Bags for Grand River Meals on Wheels Recipients
    • Report to Our Communities
    • Giving Opportunities
    • Grand River Hospital District Map
    • Community Information
    • Board of Directors
      • Board of Director’s Meeting Agendas
      • Board Meetings Schedule
    • Administrative Directors
    • News
    • Videos
  • Services
    • Grand River Health – Rifle
    • Grand River Health – Battlement Mesa\Parachute
  • Care Center
  • Provider Search
  • Patients and Visitors
    • Billing and Insurance
      • Commitment to Charity Care
      • Costs of Common Healthcare Needs
      • Discounts and Options
    • Colorado End-of-Life Options Act
    • Facility Maps
    • Forms
    • Grand River Health Patient Portal
    • Local Resources
    • Patient-Centered Medical Home
    • Release My Health Records
    • Rights & Privacy
      • How to File a Complaint
      • Non Discrimination Statement
      • Patient Rights and Responsibilities
    • Visitation by Support Persons, Family Members and Visitors
    • 2022 Community Health Needs Assessment
    • Household Medication And Sharps Takeback Program
  • Careers
    • Jobs
    • Living In Rifle

Forms

Home » Patients & Visitors » Forms
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

English
Spanish
English
  1. Clinic New Patient Form
  2. Clinic Medical Records Release
  3. Neurosurgery New Patient Forms English
  4. General Surgery New Patient Form
  5. Child History Questionnaire English
  6. Orthopaedic New Patient Forms
  7. ENT Intake form English
  8. Womens Health Questionnaire
  9. Consent to Treat a Minor
  10. Mens Health Questionnaire
  11. CIIS questions
  12. Wound Care Intake Form
  13. Podiatric New Patient Form
  14. Sports Clearance Exam Form
  15. Rehab Balance Confidence Scale Form
  16. Rehab Dizziness Handicap Inventory
  17. Rehab LEFS Form
  18. Rehab Low Back Pain Form
  19. Rehab Neck Disability Form
  20. Rehab Pain Sheet
  21. Rehab QuickDash Form
Spanish
  1. Formularios para pacientes nuevos en la clínica
  2. Divulgación de expdientes médicos de la clínica
  3. Formularios para pacientes nuevos del Neurosurgery
  4. Pacientes nuevos de cirugía general
  5. Cuestionario del historial del niños
  6. Formularios para pacientes nuevos de ortopedia
  7. Formulario de ORL
  8. Cuestionario de salud femenina
  9. Consentimiento para tratamiento de menores
  10. Cuestionario de salud masculina
  11. Preguntas del SIIC
  12. Tratamiento de heridas
  13. Cuestionario de la Escala de Equilibrio
  14. IDM
  15. Cuestionario del Dolor de Cabeza
  16. Cuestionario de las Extremidades Inferiores
  17. Cuestionario del Dolor Lumbar
  18. Cuestionario del Discapacidad de Cuello
  19. Cuestionario del Dolor
  20. Cuestionario de QuickDash
  21. Formularios De Evaluacion Física
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  • Appointments: 970.625.1100
  • 501 Airport Rd. Rifle, CO 81650
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Events Calendar
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  • January 2023

Calendar of Events

S Sun

M Mon

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F Fri

S Sat

0 events, 1

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2 events, 3

5:30 pm - 6:30 pm Recurring Event

Weight Loss Support Group

Healthy,Food
January 3 @ 5:30 pm - 6:30 pm Recurring Event

Weight Loss Support Group

Need some support on your weight loss journey? Join Changing Lifestyles monthly for a dietitian-led support group. Group will be held on the 1st Tuesdays of the month from 5:30 […]

Free
5:30 pm - 6:30 pm Recurring Event

Grief Support Group

heart in the trees
January 3 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

Free

1 event, 4

10:00 am - 11:00 am Recurring Event

Baby and Me

Babies
January 4 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

Wednesdays at 10 am in Changing Lifestyles Conference Room Join Changing Lifestyles at Grand River Health and their Baby and Me Group on Wednesdays at 10 am. Caregivers of babies […]

Free

0 events, 5

0 events, 6

0 events, 7

0 events, 8

0 events, 9

1 event, 10

5:30 pm - 6:30 pm Recurring Event

Grief Support Group

heart in the trees
January 10 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

Free

1 event, 11

10:00 am - 11:00 am Recurring Event

Baby and Me

Babies
January 11 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

Wednesdays at 10 am in Changing Lifestyles Conference Room Join Changing Lifestyles at Grand River Health and their Baby and Me Group on Wednesdays at 10 am. Caregivers of babies […]

Free

0 events, 12

0 events, 13

0 events, 14

0 events, 15

0 events, 16

2 events, 17

5:30 pm - 6:30 pm Recurring Event

Bariatric Surgery Support Group

Bariatric Surgery Support Group
January 17 @ 5:30 pm - 6:30 pm Recurring Event

Bariatric Surgery Support Group

Have you recently gone through bariatric surgery or are you considering? Join Changing Lifestyles each month for a bariatric surgery support group. Sessions will be led by a dietitian or […]

Free
5:30 pm - 6:30 pm Recurring Event

Grief Support Group

heart in the trees
January 17 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

Free

1 event, 18

10:00 am - 11:00 am Recurring Event

Baby and Me

Babies
January 18 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

Wednesdays at 10 am in Changing Lifestyles Conference Room Join Changing Lifestyles at Grand River Health and their Baby and Me Group on Wednesdays at 10 am. Caregivers of babies […]

Free

0 events, 19

0 events, 20

0 events, 21

0 events, 22

0 events, 23

1 event, 24

5:30 pm - 6:30 pm Recurring Event

Grief Support Group

heart in the trees
January 24 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

Free

1 event, 25

10:00 am - 11:00 am Recurring Event

Baby and Me

Babies
January 25 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

Wednesdays at 10 am in Changing Lifestyles Conference Room Join Changing Lifestyles at Grand River Health and their Baby and Me Group on Wednesdays at 10 am. Caregivers of babies […]

Free

0 events, 26

0 events, 27

0 events, 28

0 events, 29

0 events, 30

1 event, 31

5:30 pm - 6:30 pm Recurring Event

Grief Support Group

heart in the trees
January 31 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

Free

1 event, 1

10:00 am - 11:00 am Recurring Event

Baby and Me

Babies
February 1 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

Wednesdays at 10 am in Changing Lifestyles Conference Room Join Changing Lifestyles at Grand River Health and their Baby and Me Group on Wednesdays at 10 am. Caregivers of babies […]

Free

0 events, 2

0 events, 3

0 events, 4

  • There are no events on this day.
  • There are no events on this day.
January 3
January 3 @ 5:30 pm - 6:30 pm Recurring Event

Weight Loss Support Group

January 3 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

January 4
January 4 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
January 10
January 10 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

January 11
January 11 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
January 17
January 17 @ 5:30 pm - 6:30 pm Recurring Event

Bariatric Surgery Support Group

January 17 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

January 18
January 18 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
January 24
January 24 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

January 25
January 25 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
January 31
January 31 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

February 1
February 1 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

January 31
January 31 @ 5:30 pm - 6:30 pm Recurring Event

Grief Support Group

February 1
February 1 @ 10:00 am - 11:00 am Recurring Event

Baby and Me

  • There are no events on this day.
  • There are no events on this day.
  • There are no events on this day.
View Calendar

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