Kaiser Permanente - Center for Complementary Medicine

Today more Americans are using complementary and alternative care to help manage or prevent many health conditions. Many adopt them as part of their cultural and personal beliefs and to promote a greater sense of emotional, physical, and spiritual well-being.

Kaiser Permanente's
Center for Complementary Medicine Live Well. Naturally

Westminster 303-457-6260 * Lakewood 303-239-7224
Midtown 303-764-8500 * Smoky Hill 303-699-3670

Online Forms

We are now offering our forms online to save you time! Below you will find intake and consent forms for all of our services that you can view and download. You can:

Print the forms, fill them out by hand, and bring them to your appointment
Fill out the forms electronically, print them, and bring them to your appointment

Chiropractic

Initial Visit Questionnaire
Consent Form

Acupuncture

Initial Visit Questionnaire
Consent Form
Acupuncture Intake Form

Massage Therapy

Initial Visit Questionnaire
Consent Form

Integrative Medicine- MD Visits

Intake Form
Diet Journal
Personal Health Goals Form

Symptom Journal (not part of first visit paperwork)

Nutritionist

Consent Form
Intake Form
Diet Journal
Diet Journal- Lar ge Font
Personal Health Goals Form

Progress Form (not part of first visit paperwork)

Medical Information Release Forms

Below are forms that can be used if you need medical information sent to Kaiser Permanente or to another provider outside of Kaiser Permanente. All requests related to your medical records are processed through the Medical Records department at Kaiser Permanente. If you have questions please contact the Medical Records department at 303-404-4700.

Send Records to Kaiser Permanente

Release Kaiser Permanente Records

Unless your coverage includes a separate rider for chiropractic and/or acupuncture benefits, the products and services described here are provided on a fee-for-service basis, separate from and not covered under your health plan benefits, and you are financially responsible to pay for them. Clinical services are provided by providers or contractors of Kaiser Foundation Health Plan of Colorado, or employees of either Health Plan or Colorado Permanente Medical Group, P.C. Results of services vary among patients and cannot be guaranteed. For specific information about your health plan benefits, please see your Evidence of Coverage. Photos of models shown, not actual patients.

Copyright © Kaiser Permanente, 2007. All Rights Reserved