New Patient Information & Paperwork
To establish care with any provider in the Southwest Medical Group, you must first submit your new patient packet. This is to address the urgency of your needs and pair you with the right provider. Please click the links below to download the appropriate form. Print it, fill out the forms and deliver them to our New Patient Coordinator at 1311-A North Mildred Road in the medical office building on the Southwest Memorial Hospital Campus. You can also email it to firstname.lastname@example.org, mail it to us, or fax the paperwork to 970-564-2019.
Scheduling is generally based on openings, but we are happy to check the availability of a specific provider by request. Please be aware that we are experiencing a high volume of new patients so you may have to wait for an appointment. You can always use our Walk-In Clinic or visit the ER if you have an emergency before your scheduled visit.
- New Patient Packet – Adult (English)
- New Patient Packet – Adult (Spanish)
- New Patient Packet – Child (English)
- New Patient Packet – Child (Spanish)
- Gynecology Patient History Form
- Request for Information Release
The New Patient Coordinator is for patients looking for a primary care provider only. Patients looking for a specialist, including OB/GYN should call or see those respective clinics. Learn more about our services and find contact information: https://www.swhealth.org/servicesdirectory
Thank you, and we welcome the opportunity to meet your healthcare needs. In the meantime, feel free to reach out to our New Patient Coordinator at 970-516-1616!
How soon should patients expect to get an appointment?
This depends on the provider they are looking to see, their age, and the urgency of their healthcare needs.
What are the different options for patients to return the New Patient Packet?
- Drop off in person with New Patient Coordinator at 1311-A North Mildred Road in the medical office building on the Southwest Memorial Hospital Campus.
- Drop off in drop box in main lobby at 1311-A North Mildred Road in the medical office building on the Southwest Memorial Hospital Campus.
- Mail it in to SMG New Patient Coordinator: 1311-A North Mildred Road, Cortez, CO 81321
- Fax it to 970-564-2019.