Patient Forms
Jump to...
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
Patient Portal Email Authorization
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.
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.
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.
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.
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
You will need the Adobe Reader to view and print these documents.
