New Patient Forms
Mountain Family Health Centers looks forward to providing you and your family with high quality medical, dental, and behavioral health care. If you have not seen us before, please take a few moments to fill out the New Patient Paperwork linked below. Once you have submitted this paperwork, we will call you back within 2 business days of when you submit your paperwork to schedule your initial visit. If you want to get scheduled quicker, call us at 970-945-2840 about an hour after submitting your paperwork.
If you are the parent of a Roaring Fork or Eagle School District child and want to enroll them in our School-based program but do not need an appointment immediately, please fill out this enrollment packet. This will allow us to be ready to serve your child when an appointment is needed.
Patient Intake Form – English
Patient Intake Form – Spanish
School-Based Health Centers – English
School Based Health Centers – Spanish
If You Don’t Have Insurance
If you do not have health insurance, you may be entitled to discounted rates for your health care with our sliding fee scale. We can also help you enroll in insurance or different financial assistance programs. Just bring proof of income and a picture ID to a meeting with one of our enrollment specialists, to see what is available based on your income and family size.
Mountain Family Health Centers does not discriminate on the basis of race, color, creed, national origin, gender, sexual orientation, religion, age, citizenship status, veteran status, disability, gender variance, genetic information, or other legally protected status in access to, or participation in, its programs, services or activities. Mountain Family Health Centers does not discriminate in its hiring or employment practices.
How Much Could Your Visit Cost?
In accordance with Colorado law SB17-65 Transparency in Direct-Pay Health Care Pricing the prices for all of our procedures are available to you. Please visit our Pricing Information page to learn more.
Note: If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health care service provided by a health care provider at this community health center. If you are not covered by health insurance, you are strongly encouraged to contact our billing office at 970-945-2840, option 5, to discuss payment options prior to receiving a health care service from a health care provider at this community health center. Prices might not reflect the actual amount of your financial ability. No patients will be denied services based on an inability to pay. You are encouraged to speak to our billing office to determine if you are eligible for a sliding fee discount based on your income and family size. If you need assistance enrolling in a health insurance program, contact our enrollment team at 970-945-2840, option 6.
Federal Transparency in Coverage Rule: This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
Patient Rights & Responsibilities, Medical Records
Please visit our Patients’ Rights page to learn more about patient rights & responsibilities, and how Mountain Family Health Centers manages medical records.
Patient Portal
Mountain Family’s Patient Portal allows established patients to communicate easily, safely, and securely over your computer or mobile device.
