FORMS

On your first visit to the Uncompahgre Medical Center, we will need some basic information about your health history.
You can either come twenty minutes early for your scheduled appointment, and fill out forms in the waiting area. Or, you can find the forms below, complete them at home, and bring them in.

Click on the following links to bring up forms, or information about the UMC/Patient relationship:

Guarantor and Insurance Information

UMC Agreement Information

  Patient Privacy Policy (For Your Information)

 Acknowledgment of Receipt of Notices

Record Release Authorization for the use of Protected Health Information