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
Patient Intake Form Online Submit
Alternate Payer Online Submit (Complete this form when a person other than the patient is the responsible payer)
Release of Information Online Submit (Submit for any provider, family member, etc. you wish Dr. Leifer to communicate with)
NEW FOR TELECONFERENCE APPOINTMENTS:
Telehealth Informed Consent Online Submit
MEDICARE PATIENTS:
Medicare Private Contract Form
If you did not submit the above forms online, please print, complete the following forms within 72 hours of scheduling your initial appointment and fax to 303-831-9601 or mail to Andrew Leifer MD, 1202 Bergen Pkwy Ste 211, Evergreen CO 80439.
Personal Information Form
Office Policy Form
Patient Intake Form
Release of Information Form (Complete for any provider, family member, etc. you wish Dr. Leifer to communicate with)
Alternate Payer Form (Complete this form when a person other than the patient is the responsible payer)
Additional information about your first appointment may be found on our New Patient Introduction page.
Personal Information Online Submit
Office Policy Online Submit
Patient Intake Form Online Submit
Alternate Payer Online Submit (Complete this form when a person other than the patient is the responsible payer)
Release of Information Online Submit (Submit for any provider, family member, etc. you wish Dr. Leifer to communicate with)
NEW FOR TELECONFERENCE APPOINTMENTS:
Telehealth Informed Consent Online Submit
MEDICARE PATIENTS:
Medicare Private Contract Form
If you did not submit the above forms online, please print, complete the following forms within 72 hours of scheduling your initial appointment and fax to 303-831-9601 or mail to Andrew Leifer MD, 1202 Bergen Pkwy Ste 211, Evergreen CO 80439.
Personal Information Form
Office Policy Form
Patient Intake Form
Release of Information Form (Complete for any provider, family member, etc. you wish Dr. Leifer to communicate with)
Alternate Payer Form (Complete this form when a person other than the patient is the responsible payer)
Additional information about your first appointment may be found on our New Patient Introduction page.