Patient Forms

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 Neurology Forms

 Neuropsychology Forms

 Concussion Forms

 Head Pain Forms

 EMG Forms

 

All Blue Sky Neurology Forms

New patients: Please print and fill out all the forms below. Be sure to bring the completed forms with you for your office visit.

Consent, Payment Policy and Payment Agreement

Message Authorization and Acknowledgement of Notice of Privacy Practices

New Patient History

Patient Information

Patient Portal Email Authorization

Privacy Practices

Transparency in Healthcare Prices Act


For ALL Neuropsychology patients, please complete and return the following forms. 

You can return via fax (303-952-4396) or mail. Your providers would appreciate having these forms returned for review prior to your scheduled appointment date.

Colorado Patient Rights Information

For Children, Parents please complete: Child Health and Developmental History

For Adults: Neuropsych Adult History Form


If you are a new concussion patient who will be seeing any of our Concussion Clinic physicians, please also print and fill out the Concussion Intake Form below and bring it to your office visit as well.

Concussion Intake Form

 

If you are an EMG patient and will be have a EMG at one of our clinics, please fill out the EMG Intake Form below and bring it to your upcoming office visit.

EMG Intake Form


If you are a follow up concussion patient who will be seeing any of our Concussion Clinic physicians, please fill out the below symptom scale form for your follow up visit.

Follow Up Symptom Scale


If you are a new head pain patient who will be seeing Dr. Lane, please fill out the Head Pain Intake Form below and bring it to your upcoming office visit.

Head Pain Intake Form


If you would like to authorize the use or disclosure of your Protected Health Information (PHI) to a particular person or entity, please use the form below.

Authorization for Use/Disclosure of Protected Health Information

 

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