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Patient Forms
Do you want to be a NEW PATIENT? Scroll down to the New Patient section below
It is very important that you read and understand or ask questions prior to signing the registration forms. All consents and policies will be strictly enforced.
Welcome to Pinon Family Practice - Office Information and Policies 2024
Patient Registration Packet (Existing and New Patient intake paperwork) (For New Patients and then annually)
Telemedicine Consent & Check-In
Childhood Vaccine Policy (Pediatric and Adult Vaccine Policy)
Annual Physical Policy - Women & Annual Wellness Policy - Men (to be completed at every annual physical)
Financial Policy & Credit Card Policy (completed annually)
Authorization For Release of Medical Records FROM Pinon Family Practice
Authorization For Release of Medical Records TO Pinon Family Practice
Notice of Privacy for Protected Health Information
Colorado Immunization Registry & CORHIO Health Information Exchange
Patient Portal Guide - Visit the Patient Portal page
Urgent Care vs. Emergency Room - After Hours Advice (CALL US FIRST)
“No Surprises Act” and Fee Transparency - Pinon Office Visit fee’s (not including procedures, tests, vaccines or labs)
Insurance Accepted
Pinon Family Practice accepts most major commercial insurance plans including:
CMS Medicare Part B Part B only (download the “what’s covered” app)
Anthem BCBS Colorado PPO, HMO, FEP, Medicare Advantage **Not MediBlu Plus**
United Healthcare HMO, PPO, Navigate, AARP Medicare Advantage Not "Charter" or “Centura” specific plans ***Beginning May 1, 2022, PFP WILL accept UHC, Doctors Plan***
Cigna Health HMO, PPO, POS. Local Plus, Connect, Sure-fit
Aetna Health HMO, PPO, Medicare Advantage and Prime **Not "Whole Health"
Humana Health HMO, PPO, Medicare Advantage **Not “HMO-X"
Tricare West Prime, Select, Reserve Select, Prime Remote, Retired Reserve and Young Adult plans
Coventry Health PPO network
First Health/Cofinity PPO network
Beechstreet/Multiplan PPO Network - Kaiser PPO
Rocky Mountain Health Plans PPO, HMO
Oscar PPO, Medicare (leaving Colorado January 2023)
Devoted Health Medicare Advantage Plan
Due to the numbers of changes in plans and the increasing number of new and narrow-network/employer plans, we recommend that all patients first confirm with your carrier that either Pinon Family Practice or one of our senior physicians, Dr. Darcy Scheeler or Dr. Tamara Wilson are in-network with your specific plan. All of our providers, including our Physician Assistant's and Nurse Practitioner’s bill under the same tax identification number (TIN) 84-1513573 for the Pinon Family Practice group.
At this time, we are not contracted with the following insurance carriers: CO State Medicaid (aka Health First Colorado), Colorado Access or CHP+ (Child Healthplan Plus), Denver Health Plan, Aetna - Bright Health, or Kaiser HMO.
Not Insured or Out-of-network? We offer a 15% self-pay discount - payment is due at the time of service. We will not bill for services after the fact or pending insurance verification for any reason. Pinon Family Practice Office Visit Fees
New Patients
Welcome to Pinon Family Practice!
Please read the Office Information and Policies and information detailed below before calling our schedulers to be matched with a Pinon Family Practice Provider! 303-948-2676 option#3
<Click Here> to read more about our office information and policies. It is important that you understand all of our policies and consents prior to seeing a Pinon Family Practice.
Before your visit, we request that you confirm that your specific insurance plan is in-network. Due to the numbers of changes in plans and the increasing number of new and narrow-network/employer plans, we recommend that all patients first confirm with your carrier that either Pinon Family Practice or one of our senior physicians, Dr. Darcy Scheeler or Dr. Tamara Wilson are in-network with your specific plan. All of our providers, including our Physician Assistant's and Nurse Practitioner’s bill under the same tax identification number (TIN) 84-1513573 for the Pinon Family Practice group.
At this time, we are not contracted with the following insurance carriers: CO State Medicaid (aka Health First Colorado), Colorado Access or CHP+ (Child Healthplan Plus), Denver Health Plan, Bright Health, or Kaiser HMO.
We do offer a 15% self-pay discount for non-insured/out-of-network patients. Payment is due at the time of service. We will not bill for services after the fact or pending insurance coverage verification. Pinon Family Practice Office Visit Fees 2023
For your first visit:
Bring a photo ID, your insurance card(s) and credit/debit card or HSA card to keep on file (see our Financial Policy)
A detailed list (or the physical bottle) of any medications, including over-the-counter drugs you take on a daily basis. Be sure to include exact name, dose taken, quantity take per day and/or specific time of day and any other details provided. Print a medication log <click here>
Fill out the three Questionnaires sent to your patient portal (should have been set up at the time your visit was scheduled. If not, please call to get this set up before you come in)
Download, print and complete the Patient Registration forms
Request your previous medical records be sent to us. If your previous providers office does not have a form for you to fill out, <click here> If you have records from Kaiser, they require this form to be submitted
We look forward to meeting you and partnering with you in your healthcare!!
Contact
Call Pinon Family Practice - Scheduling - MA/Triage Line - Referrals - Medical Records - Billing - After Hours - Fax