These forms are either helpful in completing paperwork prior to your first appointment, or ones that help me do a better job of taking care of you*.
The ones you should print (using Adobe Acrobat - free), fill out, and fax to us @ 719-687-8753 or bring with you to your initial appointment are: 'Patient Contact Policy', 'Patient Billing Agreement', and the 'Notice of Receipt of Privacy Practices' (our 'Privacy Practices' are found by clicking the 'Patient Privacy' button on the left toolbar). If you have Medicare as your primary insurance, you will also need to complete the 'Waiver for Billing Medicare' form. To allow your previous records to be sent to Dr. Eads, please complete the 'Authorization to Release Healthcare Information' form - one form will work for numerous providers.
If you are coming to the office for your annual preventative exam, please print out, complete, and bring these forms with you: PHQ9Depression Scale, Ovarian Cancer Screening (women 50+ years old with or without ovaries), and the Male or Female Annual Preventative Exam Questions. If you are not able to do this before your appointment, please come 15 minutes early to your appointment so you may complete them on site and not delay your appointment.
You will be instructed to print (using Adobe Reader) the other forms if and when they are needed.
*You will need Adobe Acrobat reader, free software that may already be on your computer, to view and print out these forms. To get 'Adobe Reader',click here: http://www.adobe.com/products/acrobat/readstep2.html If you are having trouble installing or using Adobe Reader, please visit the Adobe Reader support page at
- Permission for Medication.pdf
Used to allow a school/daycare/camp administer medications.
- Ongoing Pain.pdf
- Pain Assesment.pdf
Helps document/describe your pain
- PHQ9 Depression Screening Tool1.pdf
Depression Scale (PHQ-9)done every 6 months for monitoring response to treatment
- Authorization to Release Healthcare Information ou.pdf
Form to authorize release of your medical records to another office.