New Patient Intake Form

PLease complete the form below to the best of your ability.

Once you have signed and submitted this form, a member of our office staff will be in touch with you shortly to schedule your intake appointment. .



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TELEHEALTH & IN-PERSON CLINIC VISITS

COVID-19 RESOURCES & COMMUNITY TESTING

MEDICAID & AFFORDABLE HEALTH INSURANCE

Mountain Family Health Centers is a 501(c)(3) nonprofit Federally Qualified Health Center

OUR MISSION

To provide high quality, integrated primary medical, behavioral, and dental health care in the communities we serve, with special consideration for the medically underserved, regardless of ability to pay.


970-945-2840
contact@mountainfamily.org
(general questions only)
1905 Blake Avenue, Suite 101
Glenwood Springs, CO 81601