Patient Forms

New Patient Forms

New Patient Packet PDF (v2024)
Financial, Hippa, Phone and PHQ9 PDF (v2019)
(the forms above are needed for each new patient of The Family Practice)

Dr. Christopher Phillips’ Patients

Dr Phillips New Patient Forms PDF
Payment Authorization

Records Release

Records Release to release records from The Family Practice or Dr. Christopher Phillips
Records Release to receive records at The Family Practice
Print and fill out the appropriate request. If you are requesting records from us, fax it to our office at (719) 266-5245 or send it to the office from where you are requesting records.

FMLA or Disability Form

If you require us to fill out paperwork for FMLA or disability, please print and fill out the FMLA Disability Form and drop it off with the paperwork
(failure to have this with your paperwork will result in a delay of us being able to fill it out)

MVA Paperwork

Print and fill out the MVA Paperwork, if we are billing an MVA insurance for any visits-failure to do so will cause any visits to be billed to the patient for payment.

Self Management Goals

As a patient-centered medical home, we are to encourage and support our patients to play an active role in their own health. We ask you to print up the Self Management Goals and fill it out before your next appointment. Bring it with you to your appointment and give it to the provider.