Medical Record & Other Forms
General Health History for Doctor’s Appointments
We have you fill this out when you come in for a “new patient appointment” at the Orthopaedic & Spine Center of the Rockies — or if your last appointment with one of our doctors was more than a year ago.
- Patient General Health History Form
- Medical Records Consent Form
- Disability Form (Longmont, Lafayette, Westminster)
- Consent to Treat a Minor Form
Your Medical Records
Fort Collins, Greeley, & Loveland
Contact our release of information coordinator at 970-419-7015 or call 1-800-722-7441 and ask for medical records.
- Email Contact: info@orthohealth.com
If we have your records, we will ask you to sign and date a consent form for us.
- Fax Contact: 970-493-0521
Longmont, Lafayette, Westminster
Contact our release of information coordinator at 303-772-1600 and ask for medical records.
If we have your records, we will ask you to sign and date a consent form for us.
- Fax Contact: 303-772-9317
OCR Longmont, Lafayette, and Westminster are excited to announce that we will initiate our electronic patient intake system on March 25, 2024!
PATIENT HEALTH HISTORY FORMS
- You will receive forms to complete prior to your visit via a text link.
- You may either complete the intake on your phone or copy and paste the link to complete on a tablet, laptop computer or desktop computer.
- We kindly ask that you complete these forms in a timely manner after you receive the text link.
General Medical Records Information
If you want us to send a copy of the records to you, leave the physician section blank or write “patient” or “self” in that space.
We keep patients’ charts for about 8 years; it is possible we no longer have your records.
If you had surgery at an area hospital, the hospital may have your chart. Check with the hospital medical records department. If your file is still available, you will need to sign a release form for the hospital.
Spine Health History Form
This form below is ONLY for those who have an appointment with Dr. Robert Benz MD or Dr. Bill Biggs MD for a spine or back/neck condition.
