Skip to content

Valley-Wide Health Systems medical and dental clinics are open and seeing patients. We also have telehealth appointments available for most healthcare needs.
Please call 1-833-350-1113 to get started.  Click here to visit our COVID-19 Updates page.

EnglishSpanish
  • About Us
  • Services
    • Family Medicine Services
    • Family Dental Services
    • Behavioral Health Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Alamosa Rural Training Track
  • For Patients
    • Coronavirus Updates
    • Patient Forms
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
Menu
  • About Us
  • Services
    • Family Medicine Services
    • Family Dental Services
    • Behavioral Health Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Alamosa Rural Training Track
  • For Patients
    • Coronavirus Updates
    • Patient Forms
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
For Appointments Call
833-350-1113
EnglishSpanish
Patient Portal
Pay My Bill
COVID Vaccine Appointments
Search
Close
For Appointments Call 833-350-1113
  • About Us
  • Services
    • Family Medicine Services
    • Family Dental Services
    • Behavioral Health Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Alamosa Rural Training Track
  • For Patients
    • Coronavirus Updates
    • Patient Forms
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
Menu
  • About Us
  • Services
    • Family Medicine Services
    • Family Dental Services
    • Behavioral Health Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Alamosa Rural Training Track
  • For Patients
    • Coronavirus Updates
    • Patient Forms
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us

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
Spanish
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
Spanish
Formulario Para Un Menor No Acompanado
Google Translate
EnglishSpanish

This post is also available in: English

Patient Portal
Pay My Bill
Contact Us
  • About Us
  • Services
    • Family Medicine Services
    • Family Dental Services
    • Behavioral Health Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Alamosa Rural Training Track
  • For Patients
    • Coronavirus Updates
    • Patient Forms
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us
Menu
  • About Us
  • Services
    • Family Medicine Services
    • Family Dental Services
    • Behavioral Health Services
    • Family Physical Therapy Services
    • Pharmacy
  • Special Programs
    • Nurse Family Partnership
    • Case Management and Care Coordination
    • Women, Infants and Children (WIC)
    • Community Engagement Programs
    • Reach Out & Read
    • Alamosa Rural Training Track
  • For Patients
    • Coronavirus Updates
    • Patient Forms
    • Patient Rights and Responsibilities
    • Insurance and Financial Assistance Program Information
    • Compliance
    • CIIS Registry
    • Transparency in Health Care Prices Act
    • Patient Education
  • Providers
  • Careers
  • Locations
  • Employee Resources
  • Transportation
  • News
  • Contact Us

Main Office: 128 Market Street, Alamosa, CO 81101 | 719-587-1001
© Valley-Wide Heath Systems, Inc. | Sitemap | Privacy Policy | Built by Infront Webworks

Recognized by the American Heart Association (2020)

Accredited/Certified by
The Joint Commission.

Linkedin-in
Twitter
Facebook-f
Instagram