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Forms and Instructions

 

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Allergy & Asthma

Allergy New Patient Form
Pre-Skin Testing Instructions

Dermatology

Dermatology - New Patient Form

Ear, Nose and Throat

Dizziness Questionnaire
ENT - New Patient Form
Instructions for Patients After Epley Maneuver
Instructions for Post-Operative Care after Snoring Surgery
Nasal and Sinus Questionnaire
Nasal Irrigation Instructions
Pediatric Sleep Apnea Questionnaire
Post-Operative PE Tube Instructions
Post-Operative Tonsillectomy & Adenoidectomy Instructions
Sleep Apnea Questionnaire
Voice Handicap Index

Family Medicine

Dr Jacobi New Patient Health History
Family Medicine Patient Health History

Gastroenterology

Colonoscopy — Dr. Grossman Colyte Preparation
Colonoscopy — Dr. Iqbal Miralax Preparation
Colonoscopy — Visicol Preparation Instructions
Colonoscopy Instructions
Cuestionario Para Nuevos Pacientes
Dr Grossman New Patient History
Dr. Iqbal New Patient History
Gastroscopy — EGD/Upper Endoscopy Preparation Instructions

General Surgery

Breast Cancer Risk Survey
General Surgery New Patient Form
Post Operative Wound Care Instructions

Infectious Disease

Dr. Gill's New Patient History

Internal Medicine

Internal Medicine Established Patient Form
Internal Medicine New Patient Form

Medical Records Release

Release PHI to a Family Member Form
Transfer Records from Longmont Clinic
Transfer Records To Longmont Clinic

Orthopedic Surgery

Dr Shah - New Patient Form
Dr Wood - New Patient Form
Orthopedic New Patient Form

Pediatric Medicine

Dr Isaacson New Patient Form
Dr Turner Parent Assessment
Dr Turner Teacher Evaluation
Vanderbilt Parent Form
Vanderbilt Teacher Form

Physical Medicine and Rehabilitation

Dr Gehrs New Patient Form
Dr. Gehrs Follow-up Form

Plastic Surgery

Aesthetician's New Patient Forms
Before and After Instructions for Botox and Fillers
Before and After Instructions for Noninvasive Laser Treatments
Cosmetic - New Patient Medical History Form
Laser Resurfacing of the Face — Instructions
Micro-Peel Plus Instructions
Obagi Blue Peel Instructions
Post-Operative Instructions for Blepharoplasty
Post-Operative Instructions for Endoscopic Browlift
Questions and Answers About BOTOX® Cosmetic
Wound and Scar Care Instructions
Wound Care Instructions

Radiology & Imaging

Abdominal Ultrasound Instructions
Calcium Scoring Consent Form
CAT Scan Instructions
CT Cardiac Calcium Scoring
CT Heart Scan Information
Instructions for Barium Enema
Instructions for CT Scan with Contrast
Instructions for IVP Preparation
Mammogram Instructions
MRI Instructions
Nuclear Medicine Stress Test Information
Pelvic/Obstetrical Ultrasound Instructions
Small Bowel Series

Rheumatology

Dr. Laughlin's New Patient Health History

Urology

Instructions - Post Vasectomy
Instructions for Prostate Ultrasound or Biopsy
Kidney Stones 101
Patient Instructions for TherMatrx
Post Thermatrix Information
Urology New Patient History
Vasectomy Instructions