COVID-19 Vaccine event every Friday from 10am – 2pm at Adams State University Library parking lot. Make an appointment or walk up. Offering both Moderna and Johnson & Johnson.
CaptureRx Security Incident • COVID-19 Info

For Appointments Call 833-350-1113
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Patient Forms

New Patient Forms

English
Patient Information Form
VWHS Health History Form
Notice of Privacy Practices
Authorization for Release PHI
Authorization to Request PHI
Consent to Treat for Minor Form
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Formas de informacion al Paciente
Forma de la Historia de Salud
Aviso de Practicas de Privacidad
La autorizacion para revelar la PHI
Solicitar autorizacion para la PHI
Consentimiento Para Tratar a un Menor

Other Downloadable Forms

English
Nurse Family Partnership Referral Form
Authorization to Disclose PHI
Complete Transfer of Care Authorization
Unaccompanied Minor Form
Advance Directive for Mental Health
Colorado Medical Orders for Scope of Treatment (MOST) form
Spanish
Formulario Para Un Menor No Acompanado
Forms for School Based Health Patients
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Main Office: 128 Market Street, Alamosa, CO 81101 | 719-587-1001
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Recognized by the American Heart Association (2020)

Accredited/Certified by
HRSA Health Center Program Operational Site Visit

HRSA Recognition: Advancing HIT for Quality

HRSA Recognition: COVID-19 Data Reporter

HRSA Recognition: Patient Centered Medical Home

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