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Patient Forms & Documents

Browse the tabs below to download the relevant forms and information ahead of your appointment.

Before we can schedule to review your case or arrange an initial in-office consult, we will need you to print out and complete the five forms below and send them to us via mail, fax or email.

In addition to these five forms, please arrange to send us ONLY:

  • Previous Abdominal Operative and Pathology Reports
  • Color Surgical Photos if you have them
  • Lab work completed in the last 18 months
Patient Registration Form
New Patient Questionnaire
Medical Release Form
Medical Supplement Summary
Office Policy Form

* Please mail printed forms to 1199 Main Avenue #217, Durango, CO 81301-4158, Attn: Michelle. Alternatively, you may scan and email documents to

The following documents provide essential information about how to reach our center for your first in-office appointment and your patient privacy:

HIPAA Privacy Information
Request for Special HIPAA Privacy

Additional forms as appropriate:

Confirmation of Appointment
Phone/Internet Consult Information
Request for Form or Letter
VHI Medical Release to Another Doctor
Menopause Questionnaire

The following documents provide essential information in relation to your upcoming surgery. As soon as you schedule your surgery, please print out and read this information, referring back to it as your surgery date draws closer:

Herbs and supplements to avoid prior to surgery
Things you should know about anesthesiology