Forms & Medical Records

Choose the appropriate form from the list below.

If you are a new patient, be sure to bring your completed forms, insurance information and a photo ID to expedite the registration process.

Questions? Call us at 303.398.1355.

Looking for Medical Records?

Consent Forms

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• Consent to Communicate Personal Health Information(PDF)
• Consent to Communicate Personal Health Information (Spanish)
• MyChart Request for Proxy Access (PDF)
• Care Everywhere Opt-out/Opt-in Form (PDF)

New Patient Forms

Please print, complete and fax New Patient Forms to 303.398.1211 ahead of time so we can be better prepared for your visit. If you are unable to fax, please bring it to your visit.

All new patients need to complete the Adult New Patient Questionnaire prior to their appointment.

Adult New Patient Questionnaire prior to their appointment. New ILD or Occupational Health patients need to complete the Adult New Patient ILD & Occupational Health Addendum." width="" height="" />

• Adult New Patient Questionnaire(PDF)
• Adult New Patient ILD & Occupational Health Addendum(PDF)
• Research Opt Out Authorization (PDF
• Research Opt Out Authorization(Spanish)
  • Why should I fill out the Research Recruitment Authorization?(PDF)
• Consent to TreatmentPDF)

Follow Up Visit Forms

Please print, complete and bring applicable follow-up forms to your visit. It is not necessary to provide these ahead of time.

• Adult Follow-up Visit - Pulmonary & ILD Follow-up Questionnaire(PDF)
• Adult Follow-up Visit - Asthma Self-assessment (ACT)(PDF)
• Adult Follow-up Visit - COPD Self-assessment (CAT)(PDF)
• Research Recruitment Authorization(PDF)
  • Why should I fill out the Research Recruitment Authorization?(PDF)

  Patient Education

  Consent Forms

  how and to whom National Jewish Health is authorized to provide your personal health information." />

  • Consent to Communicate Personal Health Information(PDF)
  • Consent to Communicate Personal Health Information (Spanish)
  • MyChart Request for Proxy Access (PDF)

  Other Pediatric Forms

  • Local Pediatric Patient Packet (PDF)
  • Pediatric Sleep New Patient Packet (PDF)
  • Pediatric Day Program Packet (PDF)
  • Pediatric Severe Asthma Packet (PDF)
  • Pediatric New Patient Questionnaire (PDF)
  • Referring Physician Information (PDF)
  • Research Recruitment Authorization(PDF)
    • Why should I fill out the Research Recruitment Authorization?(PDF)

    If you have been scheduled for a sleep consult, please fill out the forms below and return to us prior to your appointment.

    Please complete and submit the applicable questionnaire.

    If required by insurance, please have a referral and/or insurance authorization sent to the National Jewish Health Sleep Center.

    • Sleep Clinic Questionnaire (PDF)
    • Insomnia Clinic Sleep History Questionnaire (PDF)
    • Insomnia Clinic Sleep Diary (PDF)
    • Sleep Study Preparation Checklist (DOC)

    Consent Forms

    how and to whom National Jewish Health is authorized to provide your personal health information." />

    • Consent to Communicate Personal Health Information(PDF)
    • Consent to Communicate Personal Health Information (Spanish)

    New Patient Forms

    

    Please print, complete and fax New Patient Forms to 303.398.1211 ahead of time so we can be better prepared for your visit. If you are unable to fax, please bring it to your visit.

    All new patients need to complete the Adult New Patient Questionnaire prior to their appointment.

    Adult New Patient Questionnaire prior to their appointment. New ILD or Occupational Health patients need to complete the Adult New Patient ILD & Occupational Health Addendum." width="" height="" />

    • Adult New Patient Questionnaire(PDF)
    • Adult New Patient ILD & Occupational Health Addendum(PDF)
    • Research Recruitment Authorization(PDF)
      • Why should I fill out the Research Recruitment Authorization?(PDF)
    • Consent to TreatmentPDF)

    Follow Up Visit Forms

    Please print, complete and bring applicable follow-up forms to your visit. It is not necessary to provide these ahead of time.

    • Adult Follow-up Visit - Pulmonary & ILD Follow-up Questionnaire(PDF)
    • Adult Follow-up Visit - Asthma Self-assessment (ACT)(PDF)
    • Adult Follow-up Visit - COPD Self-assessment (CAT)(PDF)
    • Research Recruitment Authorization(PDF)
      • Why should I fill out the Research Recruitment Authorization?(PDF)

      Patient Education