Integrative Tele-Medicine

Start your journey to better health today!

New Patient Forms

  • Please download, print, and fax, email, or upload through Charm prior to your first appointment - Fax: 970-360-2347, liz@integrativehealthcolorado.com 
  • Please be ready for your tele-health appointment 5 minutes before the start time with web access if available
  • Please download and read the Office Policies to better understand how our fee-for-service billing works
  • The Medicare ABN is only required if you are have Medicare

New Patient - Office policies, pricing, scheduling, etc. (pdf)

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New Patient - How to contact Liz at IHC (pdf)

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New Patient - Privacy Policies (pdf)

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New Patient - Informed Consent (pdf)

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New Patient - Medicare ONLY patients (pdf)

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New Patient - Intake Form (pdf)

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New Patient - Medical History (pdf)

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New Lyme Patients Only - Consent To Treat (pdf)

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Established Lyme Patients Only - Monthly Symptoms List - Fill out before EVERY Appointment (pdf)

Download

Established Lyme Patients Only- Disulfiram Informed Consent (pdf)

Download

Established Patient (optional) - Allows IHC to contact other providers of your choice (pdf)

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