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Doctor and Patient

Patient Forms

New Patient Enrollment (Required for Assisted or Independent Living patients only)

The New Patient Enrollment forms can be completed online via DocuSign or by downloading the packet. The packet includes "Patient Information", "Patient History", "Acknowledgement of Receipt of Notice of Privacy Practices", Authorization for the Use or Disclosure of Protected Health Information", and "HIPAA Authorization to Release Protected Health Information". 

Please note when completing the New Patient Enrollment forms, you will need to gather specific documents.

Billing Statement and Disclosure

Please review Summit Medical Consultants' Billing Statement and Disclosure for important billing information.

Medicare Shared Saving Program Accountable Care Organizations

Summit Medical Consultants is part of an Accountable Care Organization (ACO). We've teamed up with other doctors, hospitals, and health care providers to make sure you get the best care. 

Insurance

Summit Medical Consultants accepts all major insurances. The Network Participation List includes all insurance plans we accept.

Assisted Living Patient Phone Tree

The Assisted Living Patient Phone Tree includes the patient and family line phone number, as well as contact information for Summit Medical Consultants, the Practice Manager, and the Clinical Assistant Practice Manager.

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

HIPAA Authorization to Release Protected Health Information (PHI) / Medical Records Request

To request a copy of your medical records or to release a copy of your medical records to a third party, complete the this form and mail or fax to Summit Medical Consultants.

Submit the completed form via mail or fax to:

Summit Medical Consultants

9250 E. Costilla Ave., Suite 540

Greenwood Village, CO 80112

Fax: 720-523-1654

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