Patient Forms

Looking to become an established patient?

You can help streamline the process by downloading and filling out the three forms below prior to calling for an appointment. Please note: they must be completed, printed, and turned in to our front office to go through our internal review and approval process before an appointment to establish care can be scheduled.

*Please note that we are not currently accepting new patients with chronic pain medication management needs or with an out-of-county Medicaid policy as their primary insurance coverage.

HIPAA / Privacy Notifications

Please note that due to HIPAA privacy rules, we are unable to share ANY information with spouses / family members / friends without written authorization on file. This includes if your child has just turned 18 but still lives at home. Please download the following form, fill out, and bring with to your appointment to ensure communication of your health information (including simple requests like appointment time verification) can be communicated with your loved ones.

Simply needing a one-time acute visit?

If you are a traveler and are experiencing an acute issue like strep throat, UTI, laceration, a non-displaced broken bone, etc., we can schedule the initial acute care visit without officially establishing care. Please call the front office to get on the schedule. 970.626.5123 x 1

Medical Records Requests

Click here for more information regarding requests to send out records or to request records be sent to our office.

Currently Uninsured?

All self-pay patients are offered a 35% discount on the office visit (E&M) charge when paying in full at time of service. The same discounted rate applies if you are submitting your receipts to a health sharing program.

If you would like to apply for our sliding scale program, please complete the application below. Please note that we strongly encourage you to apply for Colorado State Medicaid (Health First Colorado) before applying for sliding scale eligibility for more comprehensive coverage as sliding scale approval at MMC would apply only to office visit charges at this office. All labs, tests, and charges from other doctors or hospitals are separate.

MMC does not currently accept CICP.

Patient Portal Access

On 5/13/2020 we transitioned to a new Electronic Health Record system. This means that our old patient portal through Follow My Health will no longer be connected to your new medical records. You will NOT lose any information in there, but it will not be updated with any new information from MMC.

Moving forward, all patient communication, appointment confirmations, lab results, office notes, etc. will be posted in our new patient portal through Healow with eCW.

Please note that your old username and password will NOT work as this is an entirely new portal. Please contact the office if your current email doesn’t work as your username.

We are very excited about this new portal and hope you’ll find it to be more user friendly. Once fully activated, you’ll be able to make account payments, send messages to your provider, view records, and more! Please visit to sign up. Our office code for sign-up through their app is FADACD.

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