The following forms must be filled out, faxed to 970-686-8759 or returned at first treatment:

Consent for Care and Treatment
The Consent for Care and Treatment form gives your consent for Douglas Dewey, PT PC to furnish medical care and treatment to you as a patient, authorizes Douglas Dewey, PT to release all information necessary, including medical records to your medical benefits provider in order to secure payment and outlines your responsibility for payment of services. (View and Print – pdf)

Please use this form if you are self paying and not using insurance. (View and Print – pdf)

Medical History
The Patient Medical History form provides information needed to build your treatment plan. (View and Print – pdf)

HIPPA Notice
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or healthcare operations and other purposes that are permitted or required by law. (View and Print – pdf)