FORMS & POLICIES
TO BRING TO YOUR FIRST APPOINTMENT
1. PATIENT REGISTRATION FORM- ENGLISH or SPANISH
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
IF you are unable to bring pay-stubs as proof of income, please fill out the:
EMPLOYEE INCOME VERIFICATION FORM (your employer must fill out)
OR
SELF-EMPLOYMENT LEDGER (if you are self employed) - ENGLISH or SPANISH
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.
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