Online Forms

These forms are in pdf format and use Adobe Reader, which is integrated into most internet browser programs. Instructions on free download and installation are here if you are unable to view the forms below. Please call us at 719-527-1728, or e-mail us if you need more assistance.

Workers' Compensation Forms

• Clinic Location Map
• Injury Referral Form
• Workers' Compensation Initial History Forms

Occupational Health Service Forms

• Flu Vaccination Request Form
• Hepatitis A Vaccination Request Form
• Hepatitis B Vaccination Request Form
• Occupational Health Service Request
• Tetanus Vaccination Request Form

Employer Protocol

• Employer Protocol - page one
• Employer Protocol - page two

Family Practice

• Initial History Form
• Release of Medical Records Form

Informational VIS Forms

• Hepatitis A Vaccine Information
• Hepatitis B Vaccine Information
• Influenza (Flu) Vaccine Information
• MMR Vaccine Information
• Tetanus Vaccine Information
• Varicella (Chicken Pox) Vaccine Information