Pediatric New Patient Medical History

Please complete the Pediatric New Patient Medical History Form below before your anticipated visit.  All information is transmitted securely and safely. If you have any questions, please call Del Norte Clinic at 719-657-2418.  Thank you.

Additional Clinic
Patient Forms:

Family Medical History Form
Pediatric New Patient Family History Form
Clinic Patient Forms
Go to Clinic Patient Portal
With a smile and a helping hand, we provide quality care and service to our communities.

We will distinguish ourselves as the trusted healthcare destination.
We will provide compassionate healthcare and advocate wellness through innovative access, preventive medicine,
and collaborative partnerships within our diverse community.

OUR LOCATIONS

Rio Grande Hospital

310 County Road 14
Del Norte, CO 81132
Tel: 719-657-2510
Open: 24/7

Creede Family Practice

802 Rio Grande Avenue
Creede, CO 81130
Tel: 719-658-0929

Rio Grande
Hospital Clinic

310C County Road 14
Del Norte, CO 81132
Tel: 719-657-2418

Monte Vista Medical Clinic & Pharmacy

1033 2nd Avenue
Monte Vista, CO 81144
Tel: 719-852-8827
Pharmacy Tel: 719-628-0533

Rio Grande Hospital Clinic at South Fork

52 Jackson Street,
South Fork, CO 81154,
Tel: 719-873-5494