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Patient Forms

Thank you for choosing Boulder Community Health for your outpatient rehabilitation needs. We look forward to partnering with you to help you achieve your rehabilitation goals.

Prepare for Your First Visit (Evaluation)

  • Download, print and complete the appropriate forms. (Forms require Adobe Reader: Free download of Adobe Reader)
  • Bring forms with you to your first appointment.
  • Bring your physician's prescription/referral if required by your insurance.
  • Bring your health insurance card, photo identification, form of payment and a list of current medications.
  • Wear comfortable clothing.
  • Plan to check in 15 minutes prior to your evaluation time.
  • At the Boulder location, please allow additional time to get from the parking lot to the check in desk on the 2nd floor. (Enter through the hospital's main entrance on Balsam Avenue. Wheelchairs are available at the Balsam entrance if needed. Follow the signs to the elevators and proceed to the 2nd floor.)

Forms for All Patients

In addition to the forms above, please complete forms below based on your type of evaluation.

Counseling Evaluation Forms

Hand Therapy Evaluation Forms

Lymphedema Therapy

Occupational Therapy Evaluation Forms

Physical Therapy Evaluation Forms

Complete 1 of the following based on the primary reason for your Physical Therapy evaluation:

Speech-Language/Cognitive Therapy Evaluation Forms

Complete 1 of the following questionnaires based on the primary reason for your Speech Therapy evaluation:

Speech-Language-Cognitive Therapy - Intake Questionnaire - If your primary problem is speech, language or cognition

Speech-Language Therapy for People with Parkinson's Disease - Intake Questionnaire - If you have Parkinson's Disease

Swallowing Therapy - Intake Questionnaire - If your primary problem is swallowing

Voice Therapy - Intake Questionnaire - If your primary problem is your voice

Call 303-415-4400 if questions.

Important Information

Boulder Community Health is following current guidelines from the Centers for Disease Control and Prevention (CDC) that call for patients and visitors to continue wearing masks at Foothills Hospital and all BCH patient-care facilities.

People age 12 and older are eligible to receive COVID-19 vaccine. Learn more on our general vaccine information page.