Forms & Medical Records

Choose the appropriate form from the list below.

If you are a new patient, be sure to bring your completed forms, insurance information and a photo ID to expedite the registration process.

Questions? Call us at 303.398.1355.

Medical Records Release/HIPAA Forms

Medical records can be accessed online through your My National Jewish Health patient portal account.

Learn more

New Patient Forms

Please print, complete and fax New Patient Forms to 303.398.1211 ahead of time so we can be better prepared for your visit. If you are unable to fax, please bring it to your visit.

All new patients need to complete the Adult New Patient Questionnaire prior to their appointment.

Adult New Patient Questionnaire (PDF)
Adult New Patient ILD & Occupational Health Addendum (PDF)
Research Recruitment Authorization (PDF)
- Why should I fill out the Research Recruitment Authorization? (PDF)

Follow Up Visit Forms

Please print, complete and bring applicable follow-up forms to your visit. It is not necessary to provide these ahead of time.

Local Pediatric Patient Packet (PDF)
Pediatric Day Program Packet (PDF)
- Exclusive clinical research opportunity for families who are enrolled in the Pediatric Day Program for eczema. Learn more.
Pediatric Severe Asthma Packet (PDF)
Patient Questionnaire (PDF)
Referring Physician Information (PDF)
Research Recruitment Authorization (PDF)
- Why should I fill out the Research Recruitment Authorization? (PDF)

New Patient Forms

NJSD New Patient Information (PDF)
NJSD New Patient Sleep Intake Form (PDF)
NJSD Established Patient Intake Form (PDF)
Dr. Glidewell - New Patient Forms (PDF)
Research Recruitment Authorization (PDF)
- Why should I fill out the Research Recruitment Authorization? (PDF)

Follow Up Visit Forms

NJSD Sleep Follow Up Intake Form (PDF)
Dr. Glidewell - Follow-up Visit Forms (PDF)
Research Recruitment Authorization (PDF)
- Why should I fill out the Research Recruitment Authorization? (PDF)