After speaking with our office staff at 303-674-6074, please submit the following forms to confirm your initial appointment:
Personal Information
Office Policy
Patient Intake Form
Release of Information (Submit for any provider, family member, etc. you wish Dr. Leifer to communicate with)
If you are a patient having another person pay for your appointment, the responsible payer must fill out the following form and the patient must fill out a Release of Information form (above) for the payer:
Alternate Payer Form
If you will be seeing Dr. Leifer via Teleconference, please complete the following form:
Telehealth Informed Consent
If you are a Medicare subscriber, please complete the following form:
Medicare Private Contract Form
Additional information about your first appointment may be found on our New Patient Introduction page.
Personal Information
Office Policy
Patient Intake Form
Release of Information (Submit for any provider, family member, etc. you wish Dr. Leifer to communicate with)
If you are a patient having another person pay for your appointment, the responsible payer must fill out the following form and the patient must fill out a Release of Information form (above) for the payer:
Alternate Payer Form
If you will be seeing Dr. Leifer via Teleconference, please complete the following form:
Telehealth Informed Consent
If you are a Medicare subscriber, please complete the following form:
Medicare Private Contract Form
Additional information about your first appointment may be found on our New Patient Introduction page.