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Patient Forms

Forms, forms and more forms 🙂 What would we do without paperwork! Below are the common forms you will need to fill out as a new patient. All new patients will need to review and sign the disclosure form and the consent to treat form. If you would like us to be able to request records from your other providers you will need to fill out and sign the HIPAA Release of Information Form. Make sure to list the doctor you want us to get information from and for a gold star if you have their fax number or at least phone number that would be very helpful. In the state of Colorado there is specific guidance for naturopathic care for children under 8 years of age and for those 2 years and under as well. If you are a parent or legal guardian of a child patient please review and sign those relevant documents as well. Currently Dr. Goldenberg (ND) only sees children older than 2 years of age. 

If you need help with any of this paper work please feel free to reach out to us and we would be more than happy to assist. We know a lot of this can be confusing. You can contact us by phone, email, or fax. See our contact information here.   

Please also be advised that The Goldenberg GI Center, LLC will also send you an extensive health questionnaire via our secure patient portal. Once you are set up in our system as a patient (aka once you have a visit on the books) you will be enrolled in the patient portal. We will send you the relevant questionnaire before your first visit. We know paperwork and questionnaires can be tedious but we take this very seriously. The doctor will review your questionnaire carefully before your first visit so that you can hit the ground running and make the best use of your time. 

Disclosure Form

Consent to Treat Form

Disclosure Form for Children Under 8

Collaborative Agreement for Children

HIPAA Release of Information Form (to get your old medical records)

Consent to Discuss Care with Others

HIPAA Email Consent Form

Communication Policy

Third Party Labs

Testing Information Sheet

Goodness of Fit

Surprise Billing