Client Information

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Client's Medical/Family History

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Instructions:
Please fill out a Patient Intake Form using one of the two methods below:

  1. Click Here to Manually PRINT PDF then fill out form then scan it or fax it or email it or bring it to our office.

OR...

  1. Fill out the ONLINE PATIENT INTAKE FORMS on this page (all 3 of them) and when completed click the "Submit" button for each of the 3 formsPlease provide Patient Intake Form prior to setting your appointment. Thank you!


Richard Y. Harris, M.D.
381 Rampart Range Road

Woodland Park, Colorado, 80863
Email: wpmedicalclinic@gmail.com
Fax: 719.687.0940

Call 719-687-6088 if you have any questions.

Assignments & Authorizations

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Richard Y. Harris, MD

Woodland Park Medical Clinic