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Menu Close
  • 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
    • 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
    • Colorado End-of-Life Options Act
    • Commitment to Charity Care
    • Community Information
    • Costs of Common Healthcare Needs
    • Discounts and Options
    • Forms
    • Grand River Health Patient Portal
    • Health Navigation Tools
    • How to File a Complaint
    • Local Resources
    • Non Discrimination Statement
    • Notice of Privacy Practices
    • Aviso sobre las reglas de las practicas de privacidad
    • Patient-Centered Medical Home
    • Patient Rights and Responsibilities
    • Derechos y Deberes de los Pacientes
    • Release My Health Records
    • UPDATED: Visitation by Support Persons, Family Members and Visitors
    • 2019 Community Health Needs Assessment
  • Careers
    • Jobs
    • Employee Benefits
    • 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. HIPPA
  3. Clinic Medical Records Release
  4. Neurosurgery 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
  10. Consent to Treat a Minor
  11. Mens Health Questionnaire
  12. CIIS questions
  13. Wound Care Intake Form
  14. Podiatric New Patient Form
  15. Sports Clearance Exam Form
  16. Rehab Balance Confidence Scale Form
  17. Rehab Dizziness Handicap Inventory
  18. Rehab LEFS Form
  19. Rehab Low Back Pain Form
  20. Rehab Neck Disability Form
  21. Rehab Pain Sheet
  22. Rehab QuickDash 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 Neurosurgery
  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
  14. Cuestionario de la Escala de Equilibrio
  15. IDM
  16. Cuestionario del Dolor de Cabeza
  17. Cuestionario de las Extremidades Inferiores
  18. Cuestionario del Dolor Lumbar
  19. Cuestionario del Discapacidad de Cuello
  20. Cuestionario del Dolor
  21. Cuestionario de QuickDash
  22. Formularios De Evaluacion Física

Events Calendar

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Fri 05

Making a Recipe Work for You

March 5 @ 10:00 am - 11:00 am
Wed 10

Baby and Me (Virtual)

March 10 @ 10:00 am - 11:00 am
Wed 10

Kids say Yes to Fruit and Veggies

March 10 @ 12:00 pm - 1:00 pm
Fri 12

Kids say Yes to Fruit and Veggies

March 12 @ 10:00 am - 11:00 am
Wed 17

Baby and Me (Virtual)

March 17 @ 10:00 am - 11:00 am
View All Events

Recent Posts

  • Janssen vaccine deployed to regional sites
  • Keeping You Safe in our Respiratory Clinics at Grand River Health
  • Patient Portal Tutorial
  • Wear your Mask
  • The Importance of Receiving the Flu Vaccine
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501 Airport Road Rifle, Colorado 81650 | 970.625.1510 | Patient Portal | Privacy Information | Información de privacidad | Accessibility Statement

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