Steamboat Springs Women's Clinic

Patient Forms

We have listed below forms we use at our clinic, and grouped for when we need them filled out by the patient. Click on the link for the form below to view and print document.
All forms are in PDF format.


New Patients
Patient Information/Demographics Form
~
HIPPA Privacy Policy/Financial Policy Form
(click correct age group)
Ages 39 & Under Health History Form
or
Ages 40-50 Health History Form
or
Ages 51 & Over Health History Form
~
Right of Information
~
Records Release To Our Clinic Form


Established Patients Coming for Their Annual Exams
Annual Health History Update Form


Records Release
Records Release From Our Clinic Form
or
Records Release To Our Clinic Form


When you have the forms completed you can do one of the following:
Fax: 970-870-6441
Email: sswcmain@sswomensclinic.com
Bring them in day of your appointment or drop them off sooner.


Please call our office if you have any questions regarding these forms.
970-879-3738