After speaking with our office staff at 303-674-6074, please submit the following forms to confirm your initial appointment:
Personal Information Online Submit
Office Policy Online Submit
Adult Intake Questionnaire Online Submit
Alternate Payer form is used when a person other than the patient is the responsible payer.
Alternate Payer Online Submit
Release of Information form should be submitted for any provider, family member, etc. you wish Dr. Leifer to communicate with. Additionally, the Release of Information form is required for the Alternate Payer so Dr. Leifer can communicate with the responsible payer.
Release of Information Online Submit
NEW FOR TELECONFERENCE APPOINTMENTS:
Telehealth Informed Consent Form
If you did not submit the Adult Intake Questionnaire online above, please print, complete and bring to your first appointment the Patient Intake Form.
Patient Intake Form
If you would prefer not to submit forms online, please print, complete and fax the following forms within 72 hours of scheduling your initial appointment to 303-831-9601:
Personal Information Form
Office Policy Form
Patient Intake Form
Release of Information Form
Alternate Payer Form
Additional information about your first appointment may be found on our New Patient Introduction page.
Personal Information Online Submit
Office Policy Online Submit
Adult Intake Questionnaire Online Submit
Alternate Payer form is used when a person other than the patient is the responsible payer.
Alternate Payer Online Submit
Release of Information form should be submitted for any provider, family member, etc. you wish Dr. Leifer to communicate with. Additionally, the Release of Information form is required for the Alternate Payer so Dr. Leifer can communicate with the responsible payer.
Release of Information Online Submit
NEW FOR TELECONFERENCE APPOINTMENTS:
Telehealth Informed Consent Form
If you did not submit the Adult Intake Questionnaire online above, please print, complete and bring to your first appointment the Patient Intake Form.
Patient Intake Form
If you would prefer not to submit forms online, please print, complete and fax the following forms within 72 hours of scheduling your initial appointment to 303-831-9601:
Personal Information Form
Office Policy Form
Patient Intake Form
Release of Information Form
Alternate Payer Form
Additional information about your first appointment may be found on our New Patient Introduction page.