If you did not submit the above forms online, please print, complete the following forms within 72 hours of scheduling your initial appointment and 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)
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)