patient forms

The following forms are required for new patients, patients re-establishing care and all patients annually (forms need to be updated 1 time per year). Please fill out the appropriate forms and submit online.

Medical and Behavioral Health Forms

Patients Age 0-11

• Patient Registration Form

Patients Age 12-17

• Patient Registration Form

Patients Age 18 and older

• Patient Registration Form

Behavioral Health Mandatory Disclosures
The below mandatory disclosures are only required for patients being seen by a Behavioral Health Provider. Please click on the link with your Behavioral Health Provider's name below: 

• Lilia Luna, Psy. D. 
• Andrea Marcolla, LCSW, MSW
• Thomas Welle, LPCC, LAC
• Megan Wykhuis, MSW, LCSW

Dental Forms

Client Assistance Program (CAP)

Please fill out the form and submit online. 

Additional Behavioral Health Forms

At Northwest Colorado Health, we believe health is emotional, behavioral, and physical.  For this reason, we have all patients complete screeners on a standard basis so that we can better care for their health. Below are the emotional health screeners we use. You can complete this form online or in the office

Please do not complete these forms unless you have been specifically requested to by staff. If you are in crisis please contact 911 or the Colorado Crisis line at 1-844-493-8255. These forms may not be seen for 24-48 hours and should not be used in urgent situations.

Other forms

You can fill out and submit this form online prior to your appointment.

You can print and fill out these forms and bring them to our office. 

Consent Forms to Review

Read only. We will have copies for you to sign in the office.