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FORMS & POLICIES

TO BRING TO YOUR FIRST APPOINTMENT

  1. 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)

  2. HEALTH INFORMATION RELEASE FORM- ENGLISH or SPANISH

  3. BEHAVIORAL HEALTH CONSENT FORM - ENGLISH or SPANISH

  4. ITEMS LISTED IN THE ENROLLMENT VISIT CHECKLIST

  5. FOR DENTAL APPOINTMENT ONLY- DENTAL HEALTH HISTORY

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IF you are unable to bring pay-stubs as proof of income, please fill out the:

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EMPLOYEE INCOME VERIFICATION FORM (your employer must fill out) 

OR

SELF-EMPLOYMENT LEDGER (if you are self-employed) - ENGLISH or SPANISH 

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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. 

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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.

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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.

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  • AUTHORIZATION FOR A MINOR TO BE ACCOMPANIED BY SOMEONE OTHER THAN A PARENT/GUARDIAN - ENGLISH or SPANISH

  • AUTHORIZATION FOR TREATMENT OF A MINOR WITHOUT A PARENT/GUARDIAN PRESENT - ENGLISH or SPANISH

SALUD GENERAL FORMS & POLICIES 

PRIVACY POLICY- describes how Salud protects your health information

CONSENT FOR TREATMENT- information about the late & missed appointment policy and the financial policy

SALUD IS YOUR MEDICAL HOME- describes how Salud serves as your Medical Home

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

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