forms

Living Will Resources

Directing the future of your own healthcare when you are healthy and of sound mind is a good idea. It’s the "just in case" measure that lets your wishes be known and documented in writing before you might not be able to express those wishes.

There are many resources available to you to create a "living will" or "advance medical directives," a few helpful forms and links are below. Make sure you share copies with your family and your personal physician. If you’re unsure what you might need, we encourage you to visit with legal counsel.

Colorado Directive to withhold CPR, English
Colorado Directive to withhold CPR, Spanish
Five Wishes, a resource from Aging with Dignity

Informational Documents

Patient Info
Concierge Service

For questions, please call 970-824-9411.

Patient Forms-TMH Medical Clinic

Family Medicine and Pediatrics

New Adult Demographics Form

New Child Demographics Form

Notice of Privacy Practice (HIPAA)

Acknowledgement of Notice of Privacy Practice Form

OB/GYN

New Adult Demographics Form

New Child Demographics Form

New Gynecology Patient Form

New Obstetrics Patient Form

Notice of Privacy Practice (HIPAA)

Acknowledgement of Notice of Privacy Practice Form

Internal Medicine

New Adult Demographics Form

New Child Demographics Form

Internal Medicine Past Medical History Form

Notice of Privacy Practice (HIPAA)

Acknowledgement of Notice of Privacy Practice Form

General Surgery

New Adult Demographics Form

New Child Demographics Form

General Surgery Patient History Form

Notice of Privacy Practice (HIPAA)

Acknowledgement of Notice of Privacy Practice Form

Formas en Español

Forma de Demografía adulta aquí

Niño Demografía forma aquí