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urgent care

For urgent care and same day appointments, please call
303-457-4497

     
 

 
     

Patient Forms
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Aetna

Anthem

Blue Cross & Blue Shield

Beech Street

Cofinity/Sloan's Lake

Cigna /GreatWest Healthcare

First Health/Coventry

Humana

Medicare

MultiPlan (formerly Private HealthCare Systems)

Rocky Mountain Health Plan

United Healthcare

UHC Medicare Advantage (formerly Secure Horizons)

Worker's Comp - Select plans, please call for details.

 

If you do not see your Insurance carrier listed please call your customer service representative listed on your insurance card to verify we are contracted

 

 
 
 

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Please print, review and complete these patient forms before your appointment. You can fax the completed forms to Westmed Family Healthcare at (303) 254-4369 or bring them in with you to your visit.

 

Click on the links below to download form.

 

New Patient Forms  
 

Patient Informationpdf

Notice of Privacy Practicespdf

Authorization to Disclose Health Informationpdf

HIPAA notice and acknowledgementpdf

HIPAA Personal Designation Formpdf

Patient Medical Informationpdf

Payment Terms and Agreementspdf

 
     
Established Patient Forms  
 

Annually

Personal Information-this form needs to be updated once EVERY year. Click here for the Patient Information form.

Payment Terms and Agreements

 
     
 

Westmed Family Healthcare 12201 Pecos Street, Suite #500, Westminster, CO 80234

Phone: 303-457-4497 Fax: 303-254-4369