Did you know?
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.
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Lakewood 303-239-7224
Westminster 303-457-6260
Midtown 303-764-8500
Smoky Hill 303-699-3670
Highlands Ranch 720-348-4752

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


Initial Visit Questionnaire
Consent Form


Initial Visit Questionnaire
Consent Form
Acupuncture Intake Form

Massage Therapy

Initial Visit Questionnaire
Consent Form


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

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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