FORMS & POLICIES
TO BRING TO YOUR FIRST APPOINTMENT
PATIENT REGISTRATION FORM- ENGLISH or SPANISH and ADD A MINOR PATIENT REGISTRATION FORM ENGLISH or SPANISH (to add any minors you are also registering) OR, if you are only registering minors you are the parent/guardian of and not yourself:
MINORS ONLY PATIENT REGISTRATION FORM – ENGLISH OR SPANISH
and ADD A MINOR PATIENT REGISTRATION FORM ENGLISH OR SPANISH (to add additional minors if necessary)
ITEMS LISTED IN THE ENROLLMENT VISIT CHECKLIST
FOR DENTAL APPOINTMENT ONLY- DENTAL HEALTH HISTORY
IF you are unable to bring pay-stubs as proof of income, please fill out the:
If you are interested in a health insurance plan through Connect for Health Colorado and you (or your spouse) are offered employer health insurance, please fill out this EMPLOYEE COVERAGE TOOL.
TREATMENT OF A MINOR
All children under the age of 18 must be accompanied by a parent or a legal guardian when visiting Salud for the first time and once per year thereafter.
We understand that parents or legal guardians may not always be available to bring their children in and may wish to authorize a child to attend a visit alone or with another adult. Salud allows children age 13 and older to attend visits alone. The parent or legal guardian may authorize this in advance of the visit by completing the authorization forms below.
SALUD GENERAL FORMS & POLICIES
CONSENT FOR TREATMENT- information about the late & missed appointment policy and the financial policy
PATIENT RIGHTS & RESPONSIBILITIES- describes the rights and responsibilities of a Salud patient
IMMUNIZATION INFORMATION OPT OUT- to remove your/your child's immunization information from the
Colorado Immunization Information System