Please select the appropriate online form to complete. This will be sent automatically to APH, and once it is received you will be contacted to schedule an appointment.
You may also download and print out a paper form. If you choose this option, you will need to complete the form ENTIRELY and then fax it to APH at (719) 434-2423.
Adult Registration Form OR (Print and fill out)
Child Registration Form OR (Print and fill out)
Patient Referral Form OR (Print and fill out)
Please bring all items listed below for your first appointment:
- A photo ID
- Insurance card
- ALL medications (Including over the counter [OTC] and herbal supplements) you are currently taking. Please bring medications in the original pharmacy containers.
- Copies of reports, lab results (within 6 months)
- Discharge papers
- The following forms (Completely filled out and signed)
Please note that payment is due at time of services. We will be happy to provide you with a billing form for your insurance in the event that your insurance is not accepted at this time.